Case Study of a School Surveillance System

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Project SHARE (School Health and Absenteeism Reporting Exchange) began as an idea to link schools and public health for early event detection for bioterrorism events, as well as identification and management of both large- and small-scale outbreaks. The vision was to create an electronic surveillance system that had minimal workload impact on the school staff, provided regular updated data to public health agencies for analysis, and built an informal network of collaboration between front-line school nurses and public health.The project is a collaboration between the County of San Diego, the state's local county Office of Education, and school districts throughout San Diego County. Funding was made available from the Centers for Disease Control and Prevention through bioter-rorism preparedness funds.

The project began formally with Board of Supervisors approval and authorization for the expenditure of project funds in June 2003.The County of San Diego contracted with Voxiva, a transnational company specializing in information solutions, to develop and customize Project SHARE as a dual web-telephony application. The objective was to allow higher and lower technology schools and school districts to collaborate on data entry by supporting data entry through both digital phone applications and Internet applications. Data collected through a password protected website or toll-free telephone portals are stored directly into a database. No confidential or student identifying information is collected. Rather, information is collected on a daily basis about overall attendance and the symptoms students experienced leading to health office visits. Reporting requires a minimal time commitment. The users of Project Share data (school nurses and health administrators) can monitor the information in real time through web-based interfaces. Figure 24.3 shows an illustration of a sample report from the system. Users can also extract data from the web-based system into easy-to-use Excel spreadsheets. Data are also accessed and analyzed by the county's Community Epidemiology Branch within the Health and Human Services Agency, which looks for trend information and identifies and investigates abnormal levels of activity, in collaboration with school health practitioners.

The Community Epidemiology Branch worked closely with the Office of Education in designing the Project SHARE system. The Office of Education also played a role in identifying selected schools that would serve as pilot schools during the first year of implementation. The pilot schools were selected based upon a geographic distribution and for school nurses who expressed interest in participating in the pilot project. To insure the success of the system, the Office solicited extensive school nurse input in the design and implementation of Project SHARE.

The pilot year of Project SHARE was evaluated by an external group from University of California at San Diego led by David Kirsh. This evaluation took the following factors into consideration:

• System usage (e.g., data entry and data retrieval)

• Value of the system to schools and their staff

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