title: Integration of syndromic surveillance data into public health practice at state and local levels in North Carolina.
abstract: OBJECTIVE
  We sought to describe the integration of syndromic surveillance data into daily surveillance practice at local health departments (LHDs) and make recommendations for the effective integration of syndromic and reportable disease data for public health use.
  
  
  METHODS
  Structured interviews were conducted with local health directors and communicable disease nursing staff from a stratified random sample of LHDs from May through September 2009. Interviews captured information on direct access to the North Carolina syndromic surveillance system and on the use of syndromic surveillance information for outbreak management, program management, and the creation of reports. We analyzed syndromic surveillance system data to assess the number of signals resulting in a public health response.
  
  
  RESULTS
  Syndromic surveillance data were used for outbreak investigation (19% of respondents) and program management and report writing (43% of respondents); a minority reported use of both syndromic and reportable disease data for these purposes (15% and 23%, respectively). Receiving data from frequent system users was associated with using data for these purposes (p=0.016 and p=0.033, respectively, for syndromic and reportable disease data). A small proportion of signals (<25%) resulted in a public health response.
  
  
  CONCLUSIONS
  Use of syndromic surveillance data by North Carolina local public health authorities resulted in meaningful public health action, including both case investigation and program management. While useful, the syndromic surveillance data system was oriented toward sensitivity rather than efficiency. Successful incorporation of new surveillance data is likely to require systems that are oriented toward efficiency.
authors.affiliation: The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Institute for Public Health, Chapel Hill, NC, USA. erika.samoff@unc.edu
authors.forename: Erika
authors.initials: E
authors.lastname: Samoff
authors.forename: Anna
authors.initials: A
authors.lastname: Waller
authors.forename: Aaron
authors.initials: A
authors.lastname: Fleischauer
authors.forename: Amy
authors.initials: A
authors.lastname: Ising
authors.forename: Meredith K
authors.initials: MK
authors.lastname: Davis
authors.forename: Mike
authors.initials: M
authors.lastname: Park
authors.forename: Stephanie W
authors.initials: SW
authors.lastname: Haas
authors.forename: Lauren
authors.initials: L
authors.lastname: DiBiase
authors.forename: Pia D M
authors.initials: PD
authors.lastname: MacDonald
mesh_terms: D003625:Data Collection; D018563:Disease Notification; D004196:Disease Outbreaks / Q000517:prevention & control; D006287:Health Planning Guidelines; D006801:Humans; D009111:Local Government; D009657:North Carolina / Q000453:epidemiology; D011635:Public Health Administration; D015980:Public Health Practice; D018571:Sentinel Surveillance; D013219:State Government; D013223:Statistics as Topic / Q000458:organization & administration*