Performance of an Electronic Sentinel Surveillance System for Bacterial Gastroenteritis: Mixed Methods Evaluation Study

Vollständiger Abstract

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Abstract Background Bacterial gastroenteritis remains a substantial public health burden. South Korea has operated an electronic sentinel surveillance system (SSS) since 2000; in 2023, a total of 211 sentinel hospitals conducted surveillance for 11 notifiable types of bacterial gastroenteritis. The system has not undergone a comprehensive evaluation. Objective This study evaluated the SSS’s operational performance and reporting completeness, assessed the population-based geographic allocation of sentinel sites, and explored concordance between SSS reports and National Health Insurance (NHI) claim records. Methods We conducted a mixed methods evaluation using a 2024 survey of staff at the 211 sentinel hospitals, an interview with the Korea Disease Control and Prevention Agency (KDCA) operator, KDCA operational reporting records, nationwide NHI claim records, and regional population statistics. The primary evaluation year was 2023; 2021 was a nonconsecutive descriptive comparator because these were the 2 complete annual extracts available in the analytic dataset. We calculated delayed reporting, submission completeness, and on-time completeness. Exploratory Pearson correlations compared paired weekly all-pathogen totals (52 weeks per year), annual surveillance target, and diagnosis code category counts within each age group (11 paired categories), and actual vs population-proportional sentinel allocations across 17 regions. Results Of 211 sentinel hospitals, 180 (85.3%) responded. In total, 90% (162/180) rated reporting as simple or adequate; responses on goal awareness and overall satisfaction were predominantly neutral. The delayed reporting proportion was 2.4% (255/10,652) in 2021 and 1.1% (122/10,972) in 2023; submission completeness was 99.9% (10,652/10,660) and 100% (10,972/10,972), respectively; and on-time completeness was 97.5% (10,397/10,660) and 98.9% (10,850/10,972), respectively. The exploratory weekly SSS-NHI correlation was 0.899 in 2021 and 0.937 in 2023. Age-stratified annual cross-category correlations ranged from 0.665 to 0.969 in 2021 and from 0.939 to 0.983 in 2023. Correlations between actual and population-proportional sentinel allocations were 0.946 in 2021 and 0.951 in 2023. Conclusions The SSS demonstrated favorable operational performance, with low reporting delay and near-complete submission. The claim comparison showed strong ecological comovement but cannot establish sensitivity or diagnostic equivalence because the data sources use different case definitions and counting units. Priorities are clearer communication of operational goals, standardized operator training, and future validation using patient- or episode-level data linked to laboratory results.