An investigation of pelvic inflammatory disease case reporting in Hawaiʻi

Abstract

Pelvic inflammatory disease (PID) is an upper-genital tract infection that affects the female reproductive organs. PID is a notifiable disease in Hawaii with legal implications for noncompliance. Previous analyses comparing PID diagnoses in Hawaii's hospitals and the Hawaii Department of Health (HDOH) PID surveillance data, confirmed underreporting. The purpose of this dissertation was to investigate PID reporting in Hawaii so that the necessary strategies for PID surveillance improvement can be identified and executed. A survey on PID knowledge, attitudes, diagnosing, and reporting was completed by 486 physicians. In hierarchical regression, those 15-20 years since residency were less likely to report PID than those <15 years since residency, and increased PID diagnosing and reporting knowledge increases the odds of PID reporting by 1.63 times. Findings suggest strategies for targeted education of physicians as well as the need to simplify the reporting process. Increased PID-related communication between HDOH and physicians is essential, and physicians should be provided technical assistance with reporting. Study 2 assessed the concordance between physician self-disclosed PID reporting data from a survey and actual PID reports from the HDOH PID surveillance system using Cohen's kappa. In analysis I, data were linked by physician name, and there was "slight agreement." In analysis II, linkage was according to physician practice setting, and there was "substantial agreement." It is clear that discordance exists, and further research is needed to address physician, practice setting, and HDOH issues around PID reporting. The final study aimed to answer, "How do health administrators view the mandated disease reporting system, with a focus on PID reporting?" In this qualitative study, we utilized Situational Analysis and interviewed key administrative stakeholders. After analysis, it was clear that PID is not being reported because people are not aware of the disease and the law. Interviewees stressed the need for communication between all those involved in the reporting process. The findings from these three studies confirm that: 1) awareness of PID reporting is low among physicians and healthcare administrators; and 2) education about PID and the mandated disease reporting law and process is needed.