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College Health Surveillance Network

College Health Surveillance Network. James C. Turner, MD Professor of Internal Medicine Executive Director Department of Student Health National Social Norms Institute University of Virginia Sarah Van Orman, MD Executive Director University Health Services

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College Health Surveillance Network

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  1. College Health Surveillance Network James C. Turner, MD Professor of Internal Medicine Executive Director Department of Student Health National Social Norms Institute University of Virginia Sarah Van Orman, MD Executive Director University Health Services University of Wisconsin-Madison Evelyn Wiener, MD Executive Director Student Health Service University of Pennsylvania

  2. College Health Surveillance Network(CHSN) • Funded in part by CDC and UVa/NSNI. • Established a 19 school (one additional pending) network using EMR uploads of depersonalized (e.g. [MR # X 2.17] / 37.10) data to central server. • Each school IRB approval or institutional data sharing agreement.

  3. College Health Surveillance Network(CHSN) • 607,835 currently enrolled students • 19 four-year public and private not-for-profits • Types of institutions (Research 1 IHE) • Census region representation: • Northeast: 6 • South: 7 • Midwest: 4 • West: 2 (3rd pending IRB) • Demographics similar to DOE data on Research 1 IHE’s. • Two schools started during spring/summer 2011.

  4. Gender CHSN National** **National Cohort of Research 1 IHE’s

  5. Age CHSN* National** * Note on Age Variables - 2 IHEs in the Network submit student age data to IPEDS every other year, so age numbers for 2 regions reflect Fall 2009 enrollments rather than Fall 2010. As such, percentages are estimations. **National Cohort of Research 1 IHE’s

  6. Level of Student CHSN National** **National Cohort of Research 1 IHE’s

  7. Ethnicity CHSN National** **National Cohort of Research 1 IHE’s

  8. Preliminary Data Analysis • Analyses of ICD9 and CPT codes during this presentation should be considered preliminary. • A new school will add 2011 data once IRB approval is received. • Data management procedures are evolving as the data base grows-may require reanalysis in the future.

  9. Epidemiology2011 (n=468,678 visits) 15 most common categories Contact dermatitis HPV Conjunctivitis Digestive system Symptoms Vaginitis • URI, pharyngitis, other respiratory symptoms - 775 visits / 10,000 enrolled • Screenings (STI, Pap Smear, TB, hypertension) • Depression • Back disorders (back pain, sciatica) • Adjustment Reaction • General symptoms (fatigue, chronic fatigue, malaise, insomnia, hypersomnia) • Menstrual disorders • Ear disorders • Urinary tract symptoms • Eating Disorders

  10. Epidemiology2011 (n= 182,268 patients) 15 most common categories of patients: Depression Vaginitis HPV Gastritis Adjustment disorder • URI, pharyngitis, other respiratory symptoms Multivariate analysis: Males to females OR 1.473, (95% CI: 1.422, 1.526) Hawaii/Pacific Islanders to White OR 1.447 (95% CI: 1.232, 1.699) West to Northeast OR 1.889, (95% CI: 1.783, 2.002) South to Northeast OR 0.820, (95% CI: 0.783-0.858) • Screenings (STI, Pap Smear, TB, hypertension) • General symptoms (fatigue, chronic fatigue, malaise, insomnia, hypersomnia) • Ear disorders • Menstrual disorders • Urinary tract symptoms • Contact dermatitis • Back disorders (back pain, sciatica) • Conjunctivitis • Digestive system symptoms (nausea, vomiting, heartburn)

  11. Epidemiology2011 Visits per Patient by DX • Eating Disorders 5.57 • Depression 2.68 • Adjustment Disorder 2.56 • Back Disorder 1.98 • HPV 1.74 • Anxiety Disorder 1.47 • Respiratory Disorder 1.39 • Menstrual Disorder 1.29 • Ear Disorder 1.24 • General Symptoms 1.24

  12. Epidemiology2011 Mental health visitsindividuals (n=468,678) (n=182,268) • Depression 16,289 6,257 • Eating disorders 10,700 2,015 • Anxiety 5,937 3,331 • Alcohol 4,412 846

  13. * Includes ICD-9 codes: Depression, major, full remission - 296.26 Depression, major, mild - 296.21 Depression, major, moderate - 296.22 Depression, major, partial remission - 296.25 Depression, major, severe - 296.23 DEPRESSION, not elsewhere classified - 311 Depressive disorder, major , recurrent episode - 296.3 Depressive disorder, Major , single episode - 296.2

  14. Influenza1/1/11-3/31/12

  15. Epidemiology2011 (n=182,268) Diagnoses of interest (individuals): • HPV 4,788 • Mononucleosis 2,183 • Strep Throat 1,590 • Genital Herpes Simplex 477 • HIV (AIDS or + test) 43 • Mumps 5 • Meningococcal 2 • Measles 0

  16. Epidemiology2011 (n=182,268) Diagnoses of interest (individuals): • Concussion 997 • DM 701 • HTN • All ages 1360 • <25 360 • 25-40 832 • Obesity/Overweight 1105

  17. Utilization of Health Services

  18. Methodology • January 1, 2011-December 31, 2012 • 19 Campuses, Medical Services • Week 1-17 607, 835 Students • Week 18-30 121,567 Students • Week 31-53 607, 835 Students

  19. All E & M codes • CHSN-Calculated number of evaluation and management codes per student in population; surrogate for visits. • ACHA Benchmarking Study-Visits per enrolled student

  20. Epidemiology

  21. Epidemiology

  22. Gender • Sept. 1, 2011-Dec. 31, 2011 • Observed “visits”/10,000 Students

  23. Ethnicity • Sept. 1, 2011-Dec. 31, 2011 • Observed “visits”/10,000 Students

  24. Vaccinations: Non-influenza

  25. Influenza Vaccinations

  26. Vaccinations: Rate per 10,000 *MMR, HPV, DTP, TDaP, Td, HiB, Hep B, Meningococcal, Varicella, Pneumovax,

  27. Pre-entrance Immunization DataPilot Project • Three schools with pre-entrance immunization data residing in electronic files • Pre-entrance immunizations Fall 2010 and Fall 2011 • 35,043 matriculating students • Fall 2010: 19, 956 students • 11,923 undergraduates • 8,033 graduate/professional students • Fall 2010: 15,087 students • 9,950undergraduates • 5,137 graduate/professional students • Separate electronic files in EMR • Requires special abstraction programming

  28. Vaccination requirements (University of Pennsylvania)

  29. Vaccination requirements (University of Virginia)

  30. Vaccination requirements (University of Wisconsin)

  31. FACTORS • Congruency with guidelines • Institutional support • Resources • Systems • Electronic records • Processes to chase non-compliant students

  32. Enforcement strategies

  33. CHALLENGES • Part-time students • Summer students • Dependents • Faculty and staff • Visitors

  34. MORE CHALLENGES • Religious/philosophical exemptions • Dependence on technology • Expense • Global exposure • Currency with updated recommendations • State and/or institutional restrictions

  35. College Health Surveillance NetworkChallenges to Implementation • IRB/data sharing agreements • Achieving agreement among health centers about use of codes and provider consistency • Differing EMR software among schools • Pre-entrance immunization and lab result data exist in separate files • Timely uploads of monthly data

  36. Meeting the Challenges • IRB/data sharing agreements: Templates & proactive monitoring of process • Achieving agreement: Active involvement of Medical Directors • Differing EMR software: Sharing abstraction programs among schools with same software • Pre-entrance data: Abstraction of these data is a new project. • Timely uploads: Automated reminder system; regular emails with highlights from data

  37. College Health Surveillance NetworkFuture • Expand the network to 150-160 schools, 2.5M enrolled students, all ten HHS regions (at least 5 schools per region). • Establish sub-population datasets • Pre-entrance electronic immunization records • Laboratory reports • Counseling center reports • Mortality data • Real time reports for syndromic surveillance

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