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Note: Many of these projects are statewide or citywide efforts that have an objective to connect every hospital to the health department. We provide the year of project inception to indicate the rate at which biosurveillance organizations are able to develop chief complaint data feeds from hospitals. DOH, Department of Health; RODS, Real-Time Outbreak and Disease Surveillance Laboratory, Center for Biomedical Informatics, University of Pittsburgh.

Note: Many of these projects are statewide or citywide efforts that have an objective to connect every hospital to the health department. We provide the year of project inception to indicate the rate at which biosurveillance organizations are able to develop chief complaint data feeds from hospitals. DOH, Department of Health; RODS, Real-Time Outbreak and Disease Surveillance Laboratory, Center for Biomedical Informatics, University of Pittsburgh.

These studies contribute to our understanding of the informational value of chief complaints for the detection of cases and of outbreaks. The studies utilized experimental methods that we discussed in Chapter 21. In this section, we review these studies and discuss how they address the following three hypotheses of interest:

Hypothesis 1: A chief complaint can discriminate between whether a patient has syndrome or disease X or not (stated as the null hypothesis: the chief complaint cannot discriminate).

Hypothesis 2: When aggregated with the chief complaints of other patients in a region, chief complaints can discriminate between whether there is an outbreak of type Y or not.

Hypothesis 3: When aggregated with the chief complaints of other patients in a region, algorithmic monitoring of chief complaints can detect an outbreak of type Y earlier than current best practice (or some other reference method).

It is important to note that the experiments that we will discuss differ in many details. They differ in the hypothesis being tested; the syndrome or type of outbreak studied; the NLP method; the detection algorithm; and the reference standard used in the experiment. Thus, achieving a "meta-analytic'' synthesis about the informational value and role of chief complaints in biosurveillance requires that we pay attention to these distinctions. The one thing these studies share in common, however, is that they are all studies of the informational value of chief complaints.

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