title: Use of syndromic surveillance at local health departments: movement toward more effective systems.
abstract: BACKGROUND
  Syndromic surveillance systems enhance public health practice in both large and small population settings. However, data from these systems are typically monitored by state and federal agencies and less frequently used by small public health agencies, such as local health departments (LHDs). Syndromic surveillance system modifications may facilitate use by LHDs.
  
  
  OBJECTIVE
  To describe syndromic surveillance system modifications and survey LHD staff to assess subsequent changes in system use.
  
  
  METHODS
  Pre- and postintervention cross-sectional analysis.
  
  
  METHODS
  North Carolina (NC) LHDs, 2009 and 2012.
  
  
  METHODS
  LHD nursing and preparedness staff.
  
  
  METHODS
  Use of syndromic surveillance data by LHDs for outbreak response, seasonal event response, program management, and stakeholder reports.
  
  
  RESULTS
  In NC, syndromic surveillance system modifications made between 2009 and 2012 included implementation of LHD-specific data "dashboards" and increased distribution of LHD-specific surveillance information by the state public health agency. Users of LHD syndromic surveillance system increased from 99 in 2009 to 175 in 2012. Twenty-seven of 28 (96%) and 62 of 72 (86%) respondents completed the 2009 and 2012 surveys, respectively. Among respondents, 23% used syndromic surveillance data for outbreak response in 2009, compared with 25% in 2012. In 2009, 46% of respondents used these data for seasonal event response, compared with 57% in 2012. Syndromic surveillance data were used for program management by 25% of respondents in 2009 (compared with 30% in 2012) and for stakeholder reports by 23% of respondents in 2009 (compared with 33% in 2012).
  
  
  CONCLUSIONS
  Syndromic surveillance system changes supported modest increases in LHD use of syndromic surveillance information. Because use of syndromic surveillance information at smaller LHD is rare, these modest increases indicate effective modification of the NC syndromic surveillance system.
authors.affiliation: North Carolina Preparedness and Emergency Response Research Center (Drs Waller and Samoff, Ms Fangman), NC Institute for Public Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Dr Samoff and Ms Fangman); and Carolina Center for Health Informatics, Department of Emergency Medicine, University of North Carolina Medical School (Drs Waller and Hakenewerth).
authors.forename: Erika
authors.initials: E
authors.lastname: Samoff
authors.forename: Mary T
authors.initials: MT
authors.lastname: Fangman
authors.forename: Anne
authors.initials: A
authors.lastname: Hakenewerth
authors.forename: Amy
authors.initials: A
authors.lastname: Ising
authors.forename: Anna E
authors.initials: AE
authors.lastname: Waller
mesh_terms: D055877:Biosurveillance; D003430:Cross-Sectional Studies; D003625:Data Collection / Q000379:methods; D019451:Information Management / Q000379:methods; D007407:Interviews as Topic; D009657:North Carolina; D011635:Public Health Administration