December 5, 2004
Epi Update Managing Staff:
"The reason for collecting, analyzing and disseminating information on a disease is to control that disease. Collection and analysis should not be allowed to consume resources if action does not follow."
Foege WH., International Journal of
Epidemiology 1976; 5:29-37
National Program of
Cancer Registries' Audit Findings Prove Completeness and Quality of Florida's
Cancer Registry Data
The Technical Assistance and Audit Program (TAA), a contractor of the NPCR, conducted the audit from March 14th through March 26th 2004. The TAA auditors conducted case-finding and re-abstraction to check case completeness and data quality. The audit focused on the reporting of four major cancer sites (female breast, colon and rectum, lung and bronchus, and prostate) diagnosed in hospitals during 2001. Military and Veterans Administration hospitals were not included in this audit as they are not subject to State Laws. Children hospitals were excluded from this audit as well. Nine hospitals were randomly selected from 231 hospitals reporting cancer incidence to the FCDS. These nine selected hospitals were categorized based on caseload into low (25 to 565 cases), medium (566 to 1,131 cases), and high (1,132 to 1,697 of cases).
For case-finding, six months of records were examined in the low-caseload facilities, four months of records were examined in the medium-caseload facilities, and three months of records were examined in the high-caseload facilities. The level of case completeness during a selected period was assessed by independently case-finding cancer cases in the sample facilities utilizing various sources of medical information. These sources of medical information included the medical records disease indices (MRDI), pathology reports, cytology reports, surgical logbooks and same-day-surgery logbooks, outpatient clinic records, radiation therapy clinic logs, nuclear-medicine logs, and any other hospital source providing cancer diagnosis and treatment information. Any incident case identified during the audit, which was not collected by the FCDS, was considered a missed case.
The TAA auditors identified from the various case-finding sources in these hospitals that 2,167 cases should have been reported to the FCDS as a cancer case. Of the 2,167 cases, only 91 cases were “missed”. Of the 91 missed cases, there were 27 missed colon and rectum cases, 25 missed female breast cancer cases, 21 missed lung and bronchus cases, and 18 missed prostate cancer cases. The majority of missed cases were found in the low-caseload facilities (48) and the medium-caseload facilities (41). Only two cases were missed in the high-caseload hospitals.
The overall FCDS case completeness was 95.8 percent, which exceeds the standard set by the Centers for Disease Control and Prevention, which states “ninety-five percent of unduplicated, expected malignant cases of reportable cancer occurring in State residents should be reported within 24 months of the close of each diagnosis year.”
To assess the data quality of collected cancer incidence by the FCDS, the auditors randomly selected 33 record from each of the nine hospitals. A total of 13 critical data elements were examined for each record. Out of a total of 3,861 possible data elements examined, 195 data elements (5.1 percent) were found to have discrepancies. The TAA auditors further classified these discrepancies as major (errors in the critical data elements that affect the incidence rate) and minor (errors in the critical data elements that may not directly affect the incidence rate). The majority of discrepancies found by the auditors were minor (59.5 percent). The overall data accuracy rate for the FCDS was estimated at 94.9 percent, comparable to the NPCR (1993-1999) mean rate of 94.8 percent (the NPCR mean rate is calculated for all state central cancer registries within the NPCR program).
Table 1. Case Completeness
Table 2. Data Quality
Tara Hylton is a cancer
epidemiologist in the Chronic Disease Epidemiology Evaluation and
Emergency Room Census
Emergency Room Census (ERC) is an early warning program maintained
When ERC was implemented in December 2000, hospitals reported their daily
census numbers either by email
Within ERC, there are three types of users: ER User, ER Monitor and ER
Super User. An ER User (hospital staff) enters emergency department census
data for a specific hospital and views reports for that hospital only. ER
Monitors (county health department staff) are able to view
regional, county, and
hospital data, for any county,
Three types of reports, described below, can be generated using the ERC Surveillance System.
Regional Report (chart):
Lists only those hospitals in the region that participate in ERC. This
County Report (graph and
chart): The graph displays the census number for participating hospitals.
Hospital Report (graph and
chart): The graph displays the census number, the moving average and the
standard deviation. The chart provides the census number, moving average,
standard deviation, and any aberrations
you are interested in becoming an ER User or ER Monitor and are already an
EpiCom user, please contact an EpiCom Administrator at 850-245-4401 or by
EpiCom_Administrator@doh.state.fl.us. If you are not an EpiCom user,
log on to
https://www.epicomfl.net and choose the “click here if you are not a
registered user” link.
additional information about the ERC Surveillance System please contact
Karen Wheeler at 850-245-4401
Karen Wheeler is a
bioterrorism and special projects epidemiologist at the Bureau of
Risk Factors for
Diabetes Among Adults in Florida
This study identifies socio-demographical disparities relating to diabetes
The prevalence of diabetes and related factors were analyzed using the 2003 Florida Behavioral Risk Factor Surveillance System (BRFSS) data.
According to our data, the
prevalence of diabetes among adults in Florida has increased by 77 percent
The prevalence of diabetes among adults who engage in no physical activity
outside of work (11.1 percent) is
Nearly 12 percent of adults in Florida who have diabetes are not receiving
annual medical check-ups,
Additionally, adults with diabetes have much higher rates of hypertension
(59.4 percent) and high cholesterol
People with diabetes who get the flu are at a high risk for developing
flu-related complications. The prevalence
One out of every five (20.2 percent) adults in Florida over the age of 18
who have diabetes also smokes
Since cigarette smoking is also a risk factor for cardiovascular disease
and cerebral-vascular disease,
identifies significant risk factors for diabetes among adults in Florida.
The data indicate that diabetes
Curt Miller is a
data analyst in the Bureau of Epidemiology Chronic Disease Epidemiology Evaluation and
Surveillance Section. Dr. Youjie Huang is section administrator, and
Marie Bailey is BRFSS
New Look, Same Publication
Epi Update is sporting a brand new look with this issue.
Change is inevitable in life although
At the same time, some reprinted guidelines should
answer any questions you may have concerning correct
1. Articles must be between 250 and 2,000 words in
Jaime Forth is managing editor of, and a contributing writer to, Epi Update.
Shown to use Hydrogen to Grow
The Bureau of Epidemiology encourages
Epi Update readers to not only register on the EpiCom system at
https://www.epicomfl.net but to use features such as automatic
notification of certain events and
contribute appropriate public health observations related
to any suspicious or
unusual occurrences or circumstances. EpiCom is the
of communication between the Bureau of Epidemiology
and other state medical agencies during emergency
Pete Garner is
administrator of the Bureau of Epidemiology Surveillance Systems
Mosquito-borne Disease Update
November 21-27, 2004
West Nile (WN) virus activity: No new human cases of WN illness this week, leaving the statewide total at 41. There were four seroconversions to WN virus in sentinel chickens from Hillsborough (1) and Pinellas (3) counties. So far this year, 34 counties have reported WN activity. Brevard, Broward, Duval, Gadsden, Hillsborough and Miami-Dade counties are under medical alerts for mosquito-borne disease and Pinellas is under medical advisory for mosquito-borne diseases.
Eastern Equine Encephalomyelitis (EEE) virus activity: There were two seroconversions to EEE virus in sentinel chickens from Leon and Walton counties. Three horses in Clay, Leon and Madison counties were reported with EEE virus infections. So far this year, 33 counties have reported EEE activity.
St. Louis Encephalitis (SLE) virus activity: None this week. Four counties have reported SLE activity this year.
Highlands J (HJ) Virus activity: None this week. Twelve counties have reported HJ this year.
Cooler weather in
many parts of the state is helping to reduce mosquito populations. Where
they are still
Samantha Rivers, Caroline
Collins, Kristen Payne and Calvin DeSouza are the arbovirus
Click here to review the most recent disease figures provided by the Florida Department of Health Bureau of Epidemiology.
D'Juan Harris is a GIS
specialist in the Surveillance Systems Section of the Bureau of