Evaluation and continuous improvement of foodborne disease surveillance.

Abstract

The purpose of this thesis is to contribute to the evidence base of public health performance evaluation by applying innovative measurement and improvement methods to a foodborne disease outbreak detection and investigation process. This thesis is the results of investigation into the three following research questions: 1) can foodborne disease outbreak responder training and work experience be measured in an electronic survey, 2) what is the performance of the Minnesota Department of Health in detecting and investigating foodborne disease outbreaks, and 3) can quality improvement and evaluation tools be used to evaluate MDH process stability and capability? Three research studies were developed to address these research questions. In Chapter 1, the development and analysis of an online survey to ascertain foodborne disease outbreak responder training and work experience is described. In Chapter 2, a bacterial foodborne disease surveillance program in a state health department is described and its performance is evaluated. In Chapter 3, four processes that are conducted by a bacterial foodborne disease surveillance program are evaluated for stability and capability over three years using statistical process control charts. I conclude that methods for evaluating predictive factors of public health performance need to be improved, and that quantitative performance evaluation, within context, has great potential for improving evidenced-based public health preparedness, demonstrating changes in departmental performance, and enabling internal public health practice quality improvement.