Lyme Disease Surveillance Using Sampling Estimation: Evaluation of an Alternative Methodology in New York State.

In the 14-year period from 1993 to 2006, New York State (NYS) accounted for over one-quarter (27.1%) of all confirmed Lyme disease (LD) cases in the United States. During that time period, a nine-county area in south-east NYS accounted for 90.6% of the reported LD cases in the state. Based on concerns related to diminishing resources at both the state and local level and the increasing burden of traditional LD surveillance, the NYS Department of Health (DOH) sought to develop an alternative to traditional surveillance that would reduce the investigative workload while maintaining the ability to track LD trends by developing a system to estimate county-level LD cases based on a 20% random sample of positive laboratory reports. Estimates from this system were compared to observed cases from traditional surveillance for select counties in 2007-2009 and 2011. There were no significant differences between the two methodologies in six of nine evaluations conducted. In addition, in 93 of 98 (94.9%) demographic, symptom and other variable proportion comparisons made between the two methodologies in 2009 and 2011, there were no significant differences found. Overall, using sampling estimates was accurate and efficient in estimating LD cases at the county level. Use of case estimates for LD should be considered as a useful surveillance alternative by health policy makers for states with endemic LD.

Assessing diagnostic coding practices among a sample of healthcare facilities in Lyme disease endemic areas: Maryland and New York - A Brief Report.

The value of using diagnostic codes in Lyme disease (LD) surveillance in highly endemic states has not been well studied. Surveys of healthcare facilities in Maryland (MD) and New York (NY) regarding coding practices were conducted to evaluate the feasibility of using diagnostic codes as a potential method for LD surveillance. Most respondents indicated that their practice utilized electronic medical records (53%) and processed medical/billing claims electronically (74%). Most facilities were able to search office visits associated with specific ICD-9-CM and CPT codes (74% and 73%, respectively); no discernible differences existed between the healthcare facilities in both states. These codes were most commonly assigned by the practitioner (82%), and approximately 70% of respondents indicated that these codes were later validated by administrative staff. These results provide evidence for the possibility of using diagnostic codes in LD surveillance. However, the utility of these codes as an alternative to traditional LD surveillance requires further evaluation.

Lyme Disease Surveillance in New York State: an Assessment of Case Underreporting.

Despite the mandatory nature of Lyme disease (LD) reporting in New York State (NYS), it is believed that only a fraction of the LD cases diagnosed annually are reported to public health authorities. Lack of complete LD case reporting generally stems from (i) lack of report of provider-diagnosed cases where supportive laboratory testing is not ordered or results are negative (i.e. provider underreporting) and (ii) incomplete case information (clinical laboratory reporting only with no accompanying clinical information) such that cases are considered 'suspect' and not included in national and statewide case counts (i.e. case misclassification). In an attempt to better understand LD underreporting in NYS, a two-part study was conducted in 2011 using surveillance data from three counties. Case misclassification was assessed by obtaining medical records on suspect cases and reclassifying according to the surveillance case definition. To assess provider underreporting, lists of patients for whom ICD-9-CM code 088.81 (LD) had been used were reported to NYS Department of Health (NYSDOH). These lists were matched to the NYSDOH case reporting system, and medical records were requested on patients not previously reported; cases were then classified according to the case definition. When including both provider underreporting and case misclassification, approximately 20% (range 18.4-24.6%) more LD cases were identified in the three-county study area than were originally reported through standard surveillance. The additional cases represent a minimum percentage of unreported cases; the true percentage of unreported cases is likely higher. Unreported cases were more likely to have a history of erythema migrans (EM) rash and were more likely to be young paediatric cases. Results of the study support the assertion that LD cases are underreported in NYS. Initiatives to increase reporting should highlight the importance of reporting clinically diagnosed EM and be targeted to those providers most likely to diagnose LD, specifically providers treating paediatric patients.

Mosquito surveillance and polymerase chain reaction detection of West Nile virus, New York State.

West Nile (WN) virus was detected in the metropolitan New York City (NYC) area during the summer and fall of 1999. Sixty-two human cases, 7 fatal, were documented. The New York State Department of Health initiated a departmental effort to implement a statewide mosquito and virus surveillance system. During the 2000 arbovirus surveillance season, we collected 317,676 mosquitoes, submitted 9,952 pools for virus testing, and detected 363 WN virus-positive pools by polymerase chain reaction (PCR). Eight species of mosquitoes were found infected. Our mosquito surveillance system complemented other surveillance systems in the state to identify relative risk for human exposure to WN virus. PCR WN virus-positive mosquitoes were detected in NYC and six counties in the lower Hudson River Valley and metropolitan NYC area. Collective surveillance activities suggest that WN virus can disperse throughout the state and may impact local health jurisdictions in the state in future years.

Percutaneous transluminal coronary angioplasty in New York State. Risk factors and outcomes.

OBJECTIVE: To identify significant independent risk factors for major percutaneous transluminal coronary angioplasty outcomes. DESIGN: Retrospective analysis using univariate and logistic regression analysis to identify significant independent risk factors for adverse outcomes. SETTING: All 31 hospitals performing percutaneous transluminal coronary angioplasty in New York State in 1991. PATIENTS: All 5827 patients undergoing percutaneous transluminal coronary angioplasty between January 1, 1991, and June 30, 1991, in New York State. MAIN OUTCOME MEASURES: In-hospital mortality, major complication(s) (in-hospital mortality, myocardial infarction, and/or emergency coronary artery bypass graft), and absence of angiographic success (stenosis reduction of less than 20% on any attempted lesion or residual stenosis of at least 50% on any attempted lesion). MAIN RESULTS: Before discharge from the hospital, a total of 37 patients (0.63%) died; 67 patients (1.1%) suffered a myocardial infarction, with a mortality rate of 4.5%; and 97 patients (1.7%) underwent emergency coronary artery bypass graft surgery, with a mortality rate of 2.1% (no deaths in 85 patients who were hemodynamically stable and two deaths among 12 patients who were hemodynamically unstable). A total of 187 patients (3.2%) experienced a major complication. Angiographic success was achieved for 88% of all patients. Multivariate analysis found four independent preprocedural variables related to death: female gender, hemodynamic instability, shock, and ejection fraction. CONCLUSIONS: Percutaneous transluminal coronary angioplasty outcomes in New York compare favorably with other recent results reported in the literature. Several preprocedural variables markedly increase the incidence of adverse events.

Coronary artery bypass surgery: the relationship between inhospital mortality rate and surgical volume after controlling for clinical risk factors.

This study uses a new database containing clinical risk factors for cardiac surgery to investigate the relationship between surgical volume (hospital and surgeon) and inhospital mortality rate for all patients receiving coronary artery bypass surgery in New York State in 1989. Also, hospitals with significantly higher and lower mortality rates than expected on the basis of patient preoperative risk factors are identified. The results demonstrate that both annual surgeon volume and annual hospital volume are significantly (inversely) related to mortality rate. The 36% of all coronary bypass operations performed in hospitals with annual bypass volumes of 700 or more by surgeons with annual bypass volumes of 180 or more had a risk-adjusted mortality rate of 2.67% in comparison to a risk-adjusted mortality rate of 4.29% for other bypass operations. Furthermore, low surgical volumes were a major contributor to the outlier status of four of the five hospitals with significantly higher mortality rates than expected.

Interracial access to selected cardiac procedures for patients hospitalized with coronary artery disease in New York State.

This study examines black/white differences in the utilization of three cardiac procedures (coronary angiography, coronary artery bypass graft, and coronary angioplasty) for patients hospitalized with coronary artery disease in New York State in the first 6 months of 1987. In contrast with previous studies, disease stages are used to control for severity of illness in addition to various severity proxies. Another methodological difference is that patient episodes (a fixed period of time after an initial hospital admission) are used as the unit of analysis rather than discharges to accurately account for patients whose initial visit is to a hospital not certified to perform the procedure. After controlling for severity using logistic regression analysis, whites were found to undergo significantly more of each of the procedures than blacks (odds ratios of 1.25, 2.06, and 1.69 for angiography, bypass graft, and angioplasty, respectively). These significant differences existed for most levels of the various control variables.

Adult open heart surgery in New York State. An analysis of risk factors and hospital mortality rates.

This study analyzes data from New York State's new Cardiac Surgery Reporting System, which contains information about cardiac preoperative risk factors, postoperative complications, and hospital discharge. The purposes of the study were to determine the set of significant clinical risk factors and to identify cardiac surgical centers most likely to have serious quality-of-care problems. Significant risk factors for in-hospital death were age, gender, ejection fraction, previous myocardial infarction, number of open heart operations in previous admissions, diabetes requiring medication, dialysis dependence, disasters (acute structural defect, renal failure, cardiogenic shock, gunshot), unstable angina, intractable congestive heart failure, left main trunk narrowed more than 90%, and type of operation performed. Four of the 28 hospitals had significantly higher mortality rates than expected, given the risk factors of their patients. Subsequent site visits and medical record reviews confirmed that these facilities had high percentages of quality-of-care problems among cases resulting in mortality.