BackgroundMany health departments collaborate with community organizations on community health improvement processes. While a number of resources exist to plan and implement a community health improvement plan (CHIP), little empirical evidence exists on how to leverage and expand partnerships when implementing a CHIP. The purpose of this study was to identify characteristics of the network involved in implementing the CHIP in one large community. The aims of this analysis are to: 1) identify essential network partners (and thereby highlight potential network gaps), 2) gauge current levels of partner involvement, 3) understand and effectively leverage network resources, and 4) enable a data-driven approach for future collaborative network improvements.MethodsWe collected primary data via survey from n = 41 organizations involved in the Health Improvement Partnership of Maricopa County (HIPMC), in Arizona. Using the previously validated Program to Analyze, Record, and Track Networks to Enhance Relationships (PARTNER) tool, organizations provided information on existing ties with other coalition members, including frequency and depth of partnership and eight categories of perceived value/trust of each current partner organization.ResultsThe coalition’s overall network had a density score of 30 %, degree centralization score of 73 %, and trust score of 81 %. Network maps are presented to identify existing relationships between HIPMC members according to partnership frequency and intensity, duration of involvement in the coalition, and self-reported contributions to the coalition. Overall, number of ties and other partnership measures were positively correlated with an organization’s perceived value and trustworthiness as rated by other coalition members.ConclusionsOur study presents a novel use of social network analysis methods to evaluate the coalition of organizations involved in implementing a CHIP in an urban community. The large coalition had relatively low network density but high degree centralization—meaning key organizations link organizations otherwise not tightly partnering. Coalition members rated each other highly on trust, a positive sign for future partnership development efforts. Examination of network maps reveal key organizations that can be targeted for future partnership facilitation and expansion. Future network data collection will enable exploration of longitudinal trends and exploration of network characteristics versus health behavior, status, and outcome changes.

Background Acute gastroenteritis (AGE) causes a substantial burden in the United States, but its etiology frequently remains undetermined. Active surveillance within an integrated healthcare delivery system was used to estimate the prevalence and incidence of medically attended norovirus, rotavirus, sapovirus, and astrovirus. Methods Active surveillance was conducted among all enrolled members of Kaiser Permanente Northwest during July 2014 – June 2016. An age-stratified, representative sample of AGE-associated medical encounters were recruited to provide a stool specimen to be tested for norovirus, rotavirus, sapovirus, and astrovirus. Medically attended AGE (MAAGE) encounters for a patient occurring within 30 days were grouped into one episode, and all-cause MAAGE incidence was calculated. Pathogen- and healthcare setting-specific incidence estimates were calculated using age-stratified bootstrapping. Results The overall incidence of MAAGE was 40.6 episodes per 1000 person-years (PY), with most episodes requiring no more than outpatient care. Norovirus was the most frequently detected pathogen, with an incidence of 5.5 medically attended episodes per 1000 PY. Incidence of norovirus MAAGE was highest among children aged <5 years (20.4 episodes per 1000 PY), followed by adults aged ≥65 years (4.5 episodes per 1000 PY). Other study pathogens showed similar patterns by age, but lower overall incidence (sapovirus: 2.4 per 1000 PY, astrovirus: 1.3 per 1000 PY, rotavirus: 0.5 per 1000 PY). Conclusions Viral enteropathogens, particularly norovirus, are an important contributor to MAAGE, especially among children <5 years of age. The present findings underline the importance of judicious antibiotics use for pediatric AGE and suggest that an effective norovirus vaccine could substantially reduce MAAGE.

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I n the United States, the incidence of acute gastroenteritis (AGE) is high. AGE is estimated to cause 179 million illnesses annually (1,2). Precise data are limited on the occurrence and characteristics of sporadic AGE, particularly because the illnesses are generally mild and usually do not require medical care; may not have had diagnostic testing even if care was sought; and, depending on the pathogen, may not be reportable through public health surveillance systems. Previous US publications, using data from the US Foodborne Diseases Active Surveillance Network (FoodNet), have reported AGE prevalence ranging from 7.7 to 11%, equivalent to roughly 0.7-1.4 illnesses/person/year, depending on the recall period (i.e., 7 or 28 days) and symptom profile (i.e., diarrheal illness alone or with the presence of additional symptoms) (1,3-5). These studies have been essential in establishing estimates of AGE incidence in the community and highlighting the substantial burden of disease. However, differences in AGE case definitions have complicated efforts to compare findings across studies and time periods, and robust estimates of occurrence across the age spectrum remain limited. Consequently, there is a need to obtain all-age, population-based estimates of AGE within the United States.Even assuming the lowest reported AGE prevalence of 7.7%, there is potential for substantial disease burden on the local healthcare systems and on society, such as through lost productivity (6). Among persons with AGE, 12%-20% have reported visiting a healthcare provider to manage their symptoms, and AGE has been estimated to contribute to 2-3 million ambulatory visits and 900,000 hospitalizations per year in the United States (1,3,4,7-10). However, these data have relied on samples of persons within a geographic area who may differentially seek care depending on if they have medical insurance or access to an affordable care source. As a result, these studies may not accurately estimate the true potential burden on a healthcare system.Clarifying the etiology of AGE illness within communities and healthcare systems can help to effectively target prevention efforts. Sporadic cases of AGE are largely attributable to viral pathogens; norovirus is the most common cause of AGE across the age spectrum. Evidence in the literature suggests that intensity of viral shedding among those with asymptomatic norovirus infections is similar to that of symptomatic infections (2,8,11); however, according to transmission modeling of a healthcare-

BackgroundThis study presents a novel methodology for estimating all-age, population-based incidence rates of norovirus and other pathogens that contribute to acute gastroenteritis in the United States using an integrated healthcare delivery system as a surveillance platform.MethodsAll cases of medically attended acute gastroenteritis within the delivery system were identified from April 1, 2014 through September 30, 2016. A sample of these eligible patients were selected to participate in two phone-based surveys and to self-collect a stool sample for laboratory testing. To ascertain household transmission patterns, information on household members with acute gastroenteritis was gathered from participants, and symptomatic household members were contacted to participate in a survey and provide stool sample as well.Results54% of individuals who met enrollment criteria agreed to participate, and 76% of those individuals returned a stool sample. Among household members, 85% of eligible individuals agreed to participate, and 68% of those returned a stool sample. Participant demographics were similar to those of the eligible population, although minority racial/ethnic groups were somewhat underrepresented in the final sample.ConclusionsThis study demonstrates the feasibility of conducting acute infectious disease research within an integrated health care delivery system. The surveillance, sampling, recruitment, and data collection methods described here are broadly applicable to conduct baseline and epidemiological assessments, as well as for other research requiring representative samples of stool specimens.