title: Improving Surveillance of Sexually Transmitted Diseases through Geocoded Morbidity Assignment.
abstract: OBJECTIVE
  We assessed the added value of using a geocoder to improve sexually transmitted disease (STD) surveillance data and decision support through redistribution of inaccurately assigned morbidity in Richmond, Virginia.
  
  
  METHODS
  Virginia initiated geocoding of STD data as a data quality tool in 2002. Geocoded output files were assessed and discordant proportions of reported gonorrhea and chlamydia morbidity were reassigned appropriately for the city of Richmond, Chesterfield County, and Henrico County (2002 to 2006). We used Chi-square analysis to compare assignment proportions and calculated crude odds ratios for 2006 data to estimate increased case reassignment likelihood.
  
  
  RESULTS
  From 2002 to 2006, 149,229 cases of gonorrhea and chlamydia were reported within the Commonwealth of Virginia. Of the reported morbidity, 81% of cases (n=120,875) were successfully geocoded; 7% (n=8,461) of geocoded addresses were reassigned. Approximately 76% (n=6,412) of all reassigned cases occurred within Richmond and Chesterfield and Henrico counties. In 2006, 84% (n=654) of reassigned cases in this tri-city/county area were initially reported as Richmond morbidity. Data quality improvements reduced Richmond's artificially inflated morbidity by 18% and increased Chesterfield and Henrico morbidity by 17% and 55%, respectively. Richmond morbidity was three times more likely to be reassigned than Chesterfield cases (odds ratio [OR] = 2.93, 95% confidence interval [CI] 2.21, 3.90), and two times more likely than Henrico cases (OR=2.12, 95% CI 1.63, 2.76). Richmond's number one national rank for STD rates was reduced beginning in 2002.
  
  
  CONCLUSIONS
  Declining rates of STDs were statistically associated with geocoded morbidity reassignments. Implementation of this data quality business process has improved epidemiologic analyses, prevention planning, and assessment of resource allocations. The reduction in Richmond's national STD rankings is indicative of the effect geocoding can have on surveillance data.
authors.affiliation: Office of Epidemiology, Division of Disease Prevention, Virginia Department of Health, Richmond, VA; Department of Epidemiology and Community Health, School of Medicine, Virginia Commonwealth University, Richmond, VA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Stover
authors.affiliation: Office of Epidemiology, Division of Disease Prevention, Virginia Department of Health, Richmond, VA.
authors.forename: Khalid A
authors.initials: KA
authors.lastname: Kheirallah
authors.affiliation: Office of Epidemiology, Division of Disease Prevention, Virginia Department of Health, Richmond, VA; Virginia Health Information, Richmond, VA.
authors.forename: Philip Christopher
authors.initials: PC
authors.lastname: Delcher
authors.affiliation: Office of Epidemiology, Division of Disease Prevention, Virginia Department of Health, Richmond, VA; Current affiliation: Office of Institutional Analysis & Effectiveness, The College of William and Mary, Williamsburg, VA.
authors.forename: Carrie B
authors.initials: CB
authors.lastname: Dolan
authors.affiliation: Office of Epidemiology, Division of Disease Prevention, Virginia Department of Health, Richmond, VA.
authors.forename: LaShonda
authors.initials: L
authors.lastname: Johnson