National and Regional Representativeness of Hospital Emergency Department Visit Data in the National Syndromic Surveillance Program, United States, 2014

Abstract

Objective: We examined the representativeness of the nonfederal hospital emergency department (ED) visit data in the National Syndromic Surveillance Program (NSSP).

Methods: We used the 2012 American Hospital Association Annual Survey Database, other databases, and information from state and local health departments participating in the NSSP about which hospitals submitted data to the NSSP in October 2014. We compared ED visits for hospitals submitting data with all ED visits in all 50 states and Washington, DC.

Results: Approximately 60.4 million of 134.6 million ED visits nationwide (~45%) were reported to have been submitted to the NSSP. ED visits in 5 of 10 regions and the majority of the states were substantially underrepresented in the NSSP. The NSSP ED visits were similar to national ED visits in terms of many of the characteristics of hospitals and their service areas. However, visits in hospitals with the fewest annual ED visits, in rural trauma centers, and in hospitals serving populations with high percentages of Hispanics and Asians were underrepresented.

Conclusions: NSSP nonfederal hospital ED visit data were representative for many hospital characteristics and in some geographic areas but were not very representative nationally and in many locations. Representativeness could be improved by increasing participation in more states and among specific types of hospitals. (Disaster Med Public Health Preparedness. 2016;10:562-569).

Keywords: public health preparedness; situational awareness; syndromic surveillance.

Figure 1

Percentage of U.S. nonfederal hospital emergency department visits covered by the National Syndromic Surveillance Program in the 50 states and Washington, DC, by U.S. Department of Health and Human Services Region (R), October, 2014 *Range among states within each HHS region is the percent of nonfederal hospital emergency department visits covered by the National Syndromic Surveillance System. (For information about HHS regions: http:www.hhs.gov/iea/regions/HHS)

Figure 2

Percentage of U.S. nonfederal hospital emergency department visits covered by the National Syndromic Surveillance Program in 50 states, the Washington, DC and the Nation, October, 2014