Application of change point analysis to daily influenza-like illness emergency department visits
Abstract
BACKGROUND: The utility of healthcare utilization data from US emergency departments (EDs) for rapid monitoring of changes in influenza-like illness (ILI) activity was highlighted during the recent influenza A (H1N1) pandemic. Monitoring has tended to rely on detection algorithms, such as the Early Aberration Reporting System (EARS), which are limited in their ability to detect subtle changes and identify disease trends.
OBJECTIVE: To evaluate a complementary approach, change point analysis (CPA), for detecting changes in the incidence of ED visits due to ILI.
METHODOLOGY AND PRINCIPAL FINDINGS: Data collected through the Distribute project (isdsdistribute.org), which aggregates data on ED visits for ILI from over 50 syndromic surveillance systems operated by state or local public health departments were used. The performance was compared of the cumulative sum (CUSUM) CPA method in combination with EARS and the performance of three CPA methods (CUSUM, structural change model and Bayesian) in detecting change points in daily time-series data from four contiguous US states participating in the Distribute network. Simulation data were generated to assess the impact of autocorrelation inherent in these time-series data on CPA performance. The CUSUM CPA method was robust in detecting change points with respect to autocorrelation in time-series data (coverage rates at 90% when -0.2≤ρ≤0.2 and 80% when -0.5≤ρ≤0.5). During the 2008-9 season, 21 change points were detected and ILI…
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