Supplementing tuberculosis surveillance with automated data from health maintenance organizations

Data collected by health maintenance organizations (HMOs), which provide ca re for an increasing number of persons with tuberculosis (TB), may be used to complement traditional TB surveillance. We evaluated the ability of HMO- based surveillance to contribute to overall TB reporting through the use of routinely collected automated data for approximately 350,000 HMO members. During approximately 1.5 million person-years, 45 incident Gases were ident ified in either HMO or public health department records. Eight (18%) confir med cases had not been identified by the public health department. The most useful screening criterion (sensitivity of 89% and predictive value positi ve of 30%) was dispensing of two or more TB drugs. Pharmacy dispensing info rmation routinely collected by many HMOs appears to be a useful adjunct to traditional TB surveillance, particularly for identifying cases without pos itive microbiologic results that may be missed by traditional public health surveillance methods.