Reporting of Laboratory-Confirmed Chlamydial Infection and Gonorrhea by Providers Affiliated With Three Large Managed Care Organizations -- United States, 1995-1999

Surveillance for sexually transmitted diseases (STDs) depends on health departments receiving reports of positive STD test results from laboratories or of STD cases by clinicians. The completeness and timeliness of reporting can affect prompt sex partner notification and outbreak detection. In 1998, approximately 70 percent of chlamydia cases and 55 percent of gonorrhea cases were reported by private clinicians, including many affiliated with managed care organizations (MCOs). However, little is known about the completeness and timeliness of MCOs' STD case reporting practices. Three MCOs, three state health departments, and CDC evaluated reporting practices for chlamydial infection and gonorrhea by three large staff or group model MCOs that used different reporting procedures. The findings indicate that state health departments were notified of 78 percent-98 percent of chlamydia cases and of 64 percent-80 percent of gonorrhea cases identified in these MCOs; the median interval between specimen collection and state health department receipt of a case report was This study evaluated the chlamydia and/or gonorrhea reporting practices used during 1995-1999 by clinicians affiliated with three large MCOs: chlamydia and gonorrhea reporting at HealthPartners, a staff model HMO in Minnesota, and at Harvard Vanguard Medical Associates (HVMA), a large group practice in Massachusetts that was a staff model component of Harvard Pilgrim Health Care during the study period; and chlamydia reporting at Kaiser Permanente Foundation Health Plan of Colorado (KPCO), a group model HMO. In Minnesota and Massachusetts, clinicians and laboratories are required to report both chlamydia infection and gonorrhea, while in Colorado, only laboratories are required to report chlamydia infection.

Reporting procedures varied by MCO. In the case of HealthPartners, laboratories used a Minnesota Department of Health (MDH) form to report a positive STD test result to a patient's clinician, who was then responsible for contacting the patient, prescribing appropriate medication, noting prescribed treatments on the form, and mailing it to MDH. In the case of HVMA, laboratories transmitted a positive test result electronically to a patient's clinician and a single HVMA infection control specialist, who verified the treatment prescribed, mailed the test and treatment report to the Massachusetts Department of Public Health (MDPH), and notified the clinician that the case had been reported to MDPH. In the case of KPCO, laboratories filled out a positive STD test result reporting card provided by the Colorado Department of Public Health and Environment (CDPHE), mailed the card to CDPHE, and delivered the test result to a patient's clinician.

For this evaluation, each MCO created a database of positive tests for chlamydia infection and/or gonorrhea among MCO members. This database included all laboratory-confirmed cases of chlamydia infection and gonorrhea at HealthPartners during January 1997-December 1998 and at HVMA during January 1995 - December 1997, and all laboratory-confirmed cases of chlamydia infection at KPCO during January-June 1999. These data were transferred confidentially to the respective state STD programs for case matching to determine whether laboratory-confirmed cases had been reported to state health departments.

Laboratory-confirmed cases of chlamydia infection and gonorrhea were matched to state STD registry databases in Minnesota and Massachusetts by patient name, date of birth, sex, specimen collection date, and disease pathogen, and in Colorado by patient name, date of birth, and date of positive test. Matched cases were defined as those for which all variables matched exactly. A case initially unmatched by these variables was reclassified as matched if the patient's address, phone number, or medical record number matched, and the initial mismatch was attributed to typographic error, transposition of first and last names, or a recent last name change. Completeness of reporting was defined as the proportion of cases in the MCO database classified as matched in the state registry database. Timeliness of reporting was defined for HealthPartners and HVMA as the time between specimen collection and entry of case report into the state registry database. Because CDPHE staffing shortages precluded data entry more than once every 6 months, timeliness was defined for KPCO as the time between the date a positive test was identified in the laboratory and the date of receipt by health department staff.

At HealthPartners (Minnesota), 654 (78%) of 841 chlamydia cases and 204 (80%) of 256 gonorrhea cases were matched. Case reports were entered into MDH's registry within a median of 19 days (mean: 33 days, range: 4-380 days) and a median of 17 days (mean: 30 days, range: 6-159 days) after chlamydia and gonorrhea specimen collection, respectively. At HVMA (Massachusetts), 800 (78%) of 1,032 chlamydia cases and 225 (64%) of 354 gonorrhea cases were matched. Case reports were entered into MDPH's registry within a median of 17 days (mean: 38 days, range: 1-268 days) and a median of 14 days (mean: 14 days, range: 1-189 days) after chlamydia and gonorrhea specimen collection, respectively. At KPCO (Colorado), 226 (98%) of 231 chlamydia cases were matched. Case reports were received by CDPHE within a median of 6 days (mean: 7 days, range: 1-25 days) after the date when a positive test was identified in the laboratory.

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