1. Mapping Influenza-Like Illness (ILI) Using Physician Claims Data Larry Svenson Public Health Surveillance and Environmental Health Branch Public Health Division

2. Public Health Surveillance “Public health surveillance is the ongoing, systematic collection, analysis, and interpretation of health data essential to the planning, implementation, and evaluation of public health practice, closely integrated with the timely dissemination of these data to those who need to know…A surveillance system includes the functional capacity for data collection, analysis and dissemination…” - CDC Surveillance Update, 1988

3. Importance of Influenza Surveillance Rapidity with which epidemics evolve Widespread morbidity and the seriousness of the complications (notably pneumonia) The rate at which influenza viruses show both shifts and drifts in their surface proteins

4. Age-Standardized Influenza Mortality, Alberta 1986 to 2005

5. Number of Albertans Diagnosed with Influenza, 1983 to 2006

6. Annual Number of Cases of Influenza Treated in Emergency Departments, 1984 to 2006

7. Approach

8. Background Physicians submit electronic claims for reimbursement for services provided This information contains up to three diagnostic codes in addition to other information 82% of all physician services data is available for analysis within two weeks 90% of all physician services data is available for analysis within four weeks

9. Method The Alberta Health and Wellness data warehouse is updated on a weekly basis Data is extracted from the fee-for-service database for all physician services regardless of diagnosis Data on all emergency department claims are also extracted The data are organized by person, place, and time for each diagnosis

10. Diagnostic Groups Included Acute Respiratory Tract Infections (ICD-9-CM 460-464) Other Upper Respiratory Tract Infections (ICD-9-CM 462, 465, 470-478) Bronchitis (ICD-9-CM 466, 490) Pneumonia (ICD-9-CM 480-486) Acute Otitis Media (ICD-9-CM 382.0, 382.4, 382.9) Streptococcal Sore Throat (ICD-9-CM 034) Influenza (ICD-9-CM 487)

11. Measure Computed Case counts by week for each diagnosis for:  General practitioner offices  Emergency departments Number of influenza cases per physician Number of influenza cases per 100 patients seen Age- and sex-specific rates

12. All Transactions Registry Filter Diagnoses (460-466, 470-478, 480-487, 490) Unique ILI Services All Unique Services Filter Service Cubes Time period (e.g., 23Nov04 to 23NOV05) Select episodes Graphs Tables Episode Definition ILI Service Cubes ILI Episode Cubes Maps Storage

13. Number of Influenza Cases Diagnosed by General Practitioners by Week

14. Age-Specific Rate per 100,000 Population – Influenza (Week Ending February 24, 2007)

15. Percent Influenza Like Illness – Week Ending February 24, 2007

16. Percent Influenza Like Illness – Emergency Department

17. Number of Cases of Respiratory Disorders Diagnosed by General Practitioners by Week

18. Number of Cases of Respiratory Disorders Diagnosed in Emergency Departments by Week

19. Geographic Distribution of Influenza – Week 5 to Week 9, 2007

20. 2007 – Week 5

21. 2007 – Week 6

22. 2007 – Week 7

23. 2007 – Week 8

24. 2007 – Week 9

25. All-Cause Mortality

26. Number of Deaths (all causes) by Week

27. Age-Specific Mortality Rate per 100,000 Population (Week 9)

28. Geographic Distribution of Mortality Rates – Week 5

29. Geographic Distribution of Mortality Rates – Week 6

30. Geographic Distribution of Mortality Rates – Week 7

31. Geographic Distribution of Mortality Rates – Week 8

32. Geographic Distribution of Mortality Rates – Week 9

33. Next Steps Repackage the information to fit within Pandemic Influenza planning and monitoring Utilize the internet for dissemination to a wider audience Expand to include other disorders as part of syndromic surveillance

34. “Good surveillance does not necessarily ensure the making of right decisions, but it reduces the chances of wrong ones.” - A. D. Langmuir N Engl J Med 1963; 268: 182-191