Abstract：
BACKGROUND: Public health epidemiologists monitor data sources for disease outbreaks and other events of public health concern, but manual review of records to identify cases of interest is slow and labor-intensive and may not reflect evolving data practices. To automatically identify cases from electronic data sources, epidemiologists must use \"case definitions\" or formal logic that captures the criteria used to identify a record as a case of interest.
OBJECTIVE: To establish a methodology for development and evaluation of case definitions. A logical evaluation framework to approach case definitions will allow jurisdictions the flexibility to implement a case definition tailored to their goals and available data.
METHODS: Case definition development is explained as a process with multiple logical components combining free-text and categorical data fields. The process is illustrated with the development of a case definition to identify emergency medical services (EMS) call records related to opioid overdoses in Maryland.
METHODS: The Maryland Department of Health (MDH) installation of the Electronic Surveillance System for Early Notification of Community-Based Epidemics (ESSENCE), which began capturing EMS call records in ESSENCE in 2019 to improve statewide coverage of all-hazards health issues.
RESULTS: We describe a case definition evaluation framework and demonstrate its application through development of an opioid overdose case definition to be used in MDH ESSENCE. We show the iterative process of development, from defining how a case can be identified conceptually to examining each component of the conceptual definition and then exploring how to capture that component using available data.
CONCLUSIONS: We present a framework for developing and qualitatively assessing case definitions and demonstrate an application of the framework to identifying opioid overdose incidents from MDH EMS data. We discuss guidelines to support jurisdictions in applying this framework to their own data and public health challenges to improve local surveillance capability.
OBJECTIVE: To establish a methodology for development and evaluation of case definitions. A logical evaluation framework to approach case definitions will allow jurisdictions the flexibility to implement a case definition tailored to their goals and available data.
METHODS: Case definition development is explained as a process with multiple logical components combining free-text and categorical data fields. The process is illustrated with the development of a case definition to identify emergency medical services (EMS) call records related to opioid overdoses in Maryland.
METHODS: The Maryland Department of Health (MDH) installation of the Electronic Surveillance System for Early Notification of Community-Based Epidemics (ESSENCE), which began capturing EMS call records in ESSENCE in 2019 to improve statewide coverage of all-hazards health issues.
RESULTS: We describe a case definition evaluation framework and demonstrate its application through development of an opioid overdose case definition to be used in MDH ESSENCE. We show the iterative process of development, from defining how a case can be identified conceptually to examining each component of the conceptual definition and then exploring how to capture that component using available data.
CONCLUSIONS: We present a framework for developing and qualitatively assessing case definitions and demonstrate an application of the framework to identifying opioid overdose incidents from MDH EMS data. We discuss guidelines to support jurisdictions in applying this framework to their own data and public health challenges to improve local surveillance capability.
摘要：
背景：公共卫生流行病学家监测疾病暴发和其他公共卫生关注事件的数据来源，但是人工审查记录以识别感兴趣的案例是缓慢且劳动密集型的，并且可能无法反映不断发展的数据实践。从电子数据源自动识别案件，流行病学家必须使用“病例定义”或形式逻辑来捕获用于将记录识别为感兴趣病例的标准。
目的：建立开发和评估病例定义的方法。处理案例定义的逻辑评估框架将使司法管辖区能够灵活地实施针对其目标和可用数据的案例定义。
方法：案例定义开发被解释为具有多个逻辑组件的过程，这些逻辑组件组合了自由文本和分类数据字段。通过制定病例定义来说明该过程，以确定与马里兰州阿片类药物过量有关的紧急医疗服务（EMS）通话记录。
方法：马里兰州卫生部（MDH）安装了用于社区流行病早期通知的电子监控系统（ESSENCE），该公司于2019年开始在ESSENCE中捕获EMS通话记录，以改善全州对所有危害健康问题的覆盖。
结果：我们描述了一个病例定义评估框架，并通过开发用于MDHESSENCE的阿片类药物过量病例定义来证明其应用。我们展示了开发的迭代过程，从定义如何从概念上识别案例到检查概念定义的每个组件，然后探索如何使用可用数据捕获该组件。
结论：我们提出了一个开发和定性评估病例定义的框架，并展示了该框架在从MDHEMS数据中识别阿片类药物过量事件中的应用。我们讨论了支持司法管辖区将此框架应用于其自身数据和公共卫生挑战以提高本地监测能力的指南。
目的：建立开发和评估病例定义的方法。处理案例定义的逻辑评估框架将使司法管辖区能够灵活地实施针对其目标和可用数据的案例定义。
方法：案例定义开发被解释为具有多个逻辑组件的过程，这些逻辑组件组合了自由文本和分类数据字段。通过制定病例定义来说明该过程，以确定与马里兰州阿片类药物过量有关的紧急医疗服务（EMS）通话记录。
方法：马里兰州卫生部（MDH）安装了用于社区流行病早期通知的电子监控系统（ESSENCE），该公司于2019年开始在ESSENCE中捕获EMS通话记录，以改善全州对所有危害健康问题的覆盖。
结果：我们描述了一个病例定义评估框架，并通过开发用于MDHESSENCE的阿片类药物过量病例定义来证明其应用。我们展示了开发的迭代过程，从定义如何从概念上识别案例到检查概念定义的每个组件，然后探索如何使用可用数据捕获该组件。
结论：我们提出了一个开发和定性评估病例定义的框架，并展示了该框架在从MDHEMS数据中识别阿片类药物过量事件中的应用。我们讨论了支持司法管辖区将此框架应用于其自身数据和公共卫生挑战以提高本地监测能力的指南。
