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PHI-11.1 Data Details

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PHI-11.1 Increase the proportion of tribal and state public health agencies that provide or assure comprehensive laboratory services to support disease prevention, control, and surveillance

About the Data

Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

Data Source: 
Comprehensive Laboratory Services Survey
Changed Since the Healthy People 2020 Launch: 
Yes
Measure: 
percent
Baseline (Year): 
90 (2008)
Target: 
99
Target-Setting Method: 
10 percent improvement
Numerator: 

Number of states participating in the survey that meet the defined standards/criteria for disease prevention, control, and surveillance

Denominator: 

Number of states participating in the survey

Comparable Healthy People 2010 Objective: 
Retained from HP2010 objective
Questions Used to Obtain the National Baseline Data: 

    From the 2008 Comprehensive Laboratory Services Survey:

    [NUMERATOR:]

    Does your laboratory collect information on turn around time (TAT) that is: [Total possible points: 1]

    1. Used internally (for laboratory quality assurance and improvement only) (0.5)
    2. Used externally (to inform submitters in order to improve pre-and post-analytical quality assurance or to measure overall program productivity) (0.5)
    3. Used both internally and externally (1.0)
    4. No (0)

    Does your laboratory procedures manual contain standards for TAT (i.e., maximum acceptable TAT)? [Total possible points: 1]

    1. Yes (1)
    2. No (0)

    [If yes:] Do you monitor them for quality improvement: [Total possible points: 1]

    1. All tests (1)
    2. Most tests (≥50 percent) (0.67)
    3. Some tests (<50 percent) (0.33)
    4. None (0)

    Does your laboratory participate in the following federal surveillance and informational programs? [Please check all that apply. Total possible points: 1]

    1. Laboratory Response Network (LRN) (0.08)
    2. Emerging Infections Program (EIP) (0.08)
    3. Epidemiology Laboratory Capacity (ELC) (0.08)
    4. Foodborne Diseases Active Surveillance Network (FoodNet) (0.08)
    5. Health Alert Network (HAN) (0.08)
    6. Influenza (CDC/WHO Surveillance Network) (0.08)
    7. Arbovirus Surveillance (ArboNet) (0.08)
    8. National Enteric Respiratory Virus Surveillance System (NERVSS) (0.08)
    9. National Molecular Subtyping Network for Foodborne Disease Surveillance (PulseNet) (0.08)
    10. FERN (Food Emergency Response Network) (0.08)
    11. Elexnet (Electronic Laboratory Exchange Network) (0.08)
    12. DPDx (Laboratory Identification of Parasites of Public Health Concern) (0.08)
    13. Other (Please Specify) (0)

    Do state public health laboratory staff interact with (e.g., meet with or teleconference) the staff for the State Epidemiologist’s office on at least a weekly basis? [Total possible points: 1]

    1. Yes (1)
    2. No (0)

    Does your State Public Health Laboratory provide or assure the following? [Please check all that apply. Total possible points: 3]

    • Confirmatory identification of gonococcal isolates from clinical specimens
    1. Provide testing (1)
    2. Assure testing (0)
    3. Neither provide nor assure testing (0)
  • Confirmatory identification of gonococcal isolates from other laboratories
    1. Provide testing (1)
    2. Assure testing (0.75)
    3. Neither provide nor assure testing (0)
  • Antibiotic Susceptibility Testing for gonococcal isolates
    1. Provide testing (1)
    2. Assure testing (0.75)
    3. Neither provide nor assure testing (0)

    Which type of laboratory provides confirmatory identification of gonococcal isolates for family planning and/or STD clinics in your state? [Total possible points: 1]

    • Public Health Laboratories
    1. Yes (1)
    2. No (0)
    3. I don’t know (0)
  • Clinical Laboratories
    1. Yes (0.5)
    2. No (0)
    3. I don’t know (0)
  • National Reference Laboratories
    1. Yes (0.5)
    2. No (0)
    3. I don’t know (0)

    Which type of laboratory provides antibiotic susceptibility testing results for gonococcal isolates for family planning and/or STD clinics in your state? [Total possible points: 1]

    • Public Health Laboratories
    1. Yes (1)
    2. No (0)
    3. I don’t know (0)
  • Clinical Laboratories
    1. Yes (0.5)
    2. No (0)
    3. I don’t know (0)
  • National Reference Laboratories
    1. Yes (0.5)
    2. No (0)
    3. I don’t know (0)

    When is your laboratory available to process and culture specimens for tuberculosis? [Please check all that apply. Total possible points: 1]

    1. Five (Monday – Friday) (0.5)
    2. Six (Monday – Saturday) (0.75)
    3. Seven (Monday – Sunday) (1)

    Does your laboratory perform fluorochrome acid-fast smears on respiratory specimens submitted for mycobacterial testing? [Total possible points: 1]

    1. Yes (1)
    2. No (0)

    [If yes:] Are the results of the acid-fast smears reported to the health care provider within 24 hours from the receipt of specimen in the laboratory? [Total possible points: 1]

    1. Always (1)
    2. Most of the time (≥50 percent of the time) (0.67)
    3. Some of the time (<50 percent of the time) (0.33)
    4. Never (0)

    Is the culture identification of Mycobacterium tuberculosis complex reported to the submitter within 21 days of specimen receipt in the laboratory? [Total possible points: 1]

    1. Always (1)
    2. Most of the time (≥50 percent of the time) (0.67)
    3. Some of the time (<50 percent of the time) (0.33)
    4. Never (0)

    Which type of media is used for primary inoculation of respiratory cultures for Mycobacterium tuberculosis? [Please check all that apply. Total possible points: 1]

    1. Broth only (1)
    2. Solid only (0)

    What does your laboratory use to provide identification of Mycobacterium tuberculosis complex? [Please check all that apply. Total possible points: 1]

    1. HPLC (High Pressure Liquid Chromatography) (1)
    2. NAAT (Nucleic Acid Amplification Testing) [e.g., Mycobacterium Tuberculosis Direct Test (MTD), Polymerase Chain Reaction (PCR)] (1)
    3. Biochemicals (1)
    4. Non-amplified probe (e.g., AccuProbe) (1)
    5. Other (Please specify): (1)
    6. None of the above (0)

    Does your laboratory provide or assure testing for the following? [Total possible points: 1]

    • Streptomycin
    1. Provide testing (0.2)
    2. Assure testing (0.2)
    3. Neither provide nor assure (0)
  • Isoniazid
    1. Provide testing (0.2)
    2. Assure testing (0.2)
    3. Neither provide nor assure (0)
  • Rifampin
    1. Provide testing (0.2)
    2. Assure testing (0.2)
    3. Neither provide nor assure (0)
  • Ethambutol
    1. Provide testing (0.2)
    2. Assure testing (0.2)
    3. Neither provide nor assure (0)
  • Pyrazinamide
    1. Provide testing (0.2)
    2. Assure testing (0.2)
    3. Neither provide nor assure (0)

    Is primary drug susceptibility testing for Mycobacterium tuberculosis reported back to the submitter within 30 days of specimen receipt in the laboratory? [Total possible points: 1]

    1. Always (1)
    2. Most of the time (≥50 percent of the time) (0.67)
    3. Some of the time (<50 percent of the time) (0.33)
    4. Never (0)

    Does your laboratory regularly provide positive test results of tuberculosis testing to your state Tuberculosis Control Program within 48 hours? [Total possible points: 1]

    1. Yes (1)
    2. No (0)

    Does your laboratory provide or assure the following for influenza? [Total possible points: 2]

    • Viral Isolation for Influenza
    1. Provide testing (1)
    2. Assure testing (1)
    3. Neither provide or assure (0)
  • Viral Subtyping for Influenza
    1. Provide testing (1)
    2. Assure testing (1)
    3. Neither provide or assure (0)

    What method(s) are used to identify viral isolates for influenza? [Please check all that apply. Total possible points: 1]

    1. DFA (Direct Fluorescent Antibody) (1)
    2. CPE (Cytopathic Effect) and Hemadsorption (1)
    3. PCR (Polymerase Chain Reaction) (1)
    4. Other (Please specify:) (1)
    5. None of the above (1)

    What method(s) are used to perform subtyping of influenza isolates? [Please check all that apply. Total possible points: 1]

    1. PCR (Polymerase Chain Reaction) (1)
    2. Hemagglutinin (HA) and Hemagglutination inhibition (HI) (1)
    3. IFA (Indirect Fluorescent Antibody) (1)
    4. Other (Please specify:) (1)
    5. None of the above (1)

    For which of the following isolates does your laboratory perform Pulsed-Field Gel Electrophoresis (PFGE) typing? [Check all that apply. Total possible points: 1]

    1. Escherichia coli O157:H7 (0.25)
    2. Salmonella serotypes (0.25)
    3. Listeria monocytogenes (0.25)
    4. Shigella (0.25)

    Does your laboratory provide or assure the following laboratory tests? [Please check all that apply. Total possible points: 1]

    • Arbovirus serology
    1. Provide testing (0.09)
    2. Assure testing (0.09)
    3. Neither provide nor assure (0)
  • Hepatitis C serology
    1. Provide testing (0.09)
    2. Assure testing (0.09)
    3. Neither provide nor assure (0)
  • Legionella serology
    1. Provide testing (0.09)
    2. Assure testing (0.09)
    3. Neither provide nor assure (0)
  • Measles serology
    1. Provide testing (0.09)
    2. Assure testing (0.09)
    3. Neither provide nor assure (0)
  • Varicella serology
    1. Provide testing (0.09)
    2. Assure testing (0.09)
    3. Neither provide nor assure (0)
  • Mumps serology
    1. Provide testing (0.09)
    2. Assure testing (0.09)
    3. Neither provide nor assure (0)
  • N. meningitidis serotyping
    1. Provide testing (0.09)
    2. Assure testing (0.09)
    3. Neither provide nor assure (0)
  • Shigella serotyping
    1. Provide testing (0.09)
    2. Assure testing (0.09)
    3. Neither provide nor assure (0)
  • Salmonella serotyping
    1. Provide testing (0.09)
    2. Assure testing (0.09)
    3. Neither provide nor assure (0)
  • B. pertussis detection
    1. Provide testing (0.09)
    2. Assure testing (0.09)
    3. Neither provide nor assure (0)
  • Plasmodium identification
    1. Provide testing (0.09)
    2. Assure testing (0.09)
    3. Neither provide nor assure (0)

    Does your laboratory provide or assure testing for the following newborn conditions? [Check all that apply. Total Possible Points: 1]

    Core Panel: OA

    • IVA Isovaleric acidemia (Isovaleryl-CoA dehydrogenase)
    1. Provide testing (0.034)
    2. Assure testing (0.034)
    3. Neither provide nor assure (0)
  • GA-1 Glutaric acidemia type 1
    1. Provide testing (0.034)
    2. Assure testing (0.034)
    3. Neither provide nor assure (0)
  • HMG 3-Hydroxy, 3-methylglutaric aciduria (3-Hydroxy 3-methlglutaryl-CoA lyase)
    1. Provide testing (0.034)
    2. Assure testing (0.034)
    3. Neither provide nor assure (0)
  • MCD Multiple carboxylase (Holocarboxylase synthetase)
    1. Provide testing (0.034)
    2. Assure testing (0.034)
    3. Neither provide nor assure (0)
  • MUT Methymalonic acidemia (methylmalonyl-CoA mutase)
    1. Provide testing (0.034)
    2. Assure testing (0.034)
    3. Neither provide nor assure (0)
  • 3-MCC 3-Methylcrotonyl-CoA carboxylase
    1. Provide testing (0.034)
    2. Assure testing (0.034)
    3. Neither provide nor assure (0)
  • CBL A,B Methylmalonic acidemia (Vitamin B12 Disorders)
    1. Provide testing (0.034)
    2. Assure testing (0.034)
    3. Neither provide nor assure (0)
  • PROP Propionic acidemia (Propionyl-CoA carboxylase)
    1. Provide testing (0.034)
    2. Assure testing (0.034)
    3. Neither provide nor assure (0)
  • BKT Beta ketothiolase (mitochondrial acetoacetyl-CoA thiolase; short-chain ketoacyl thiolase; T2)
    1. Provide testing (0.034)
    2. Assure testing (0.034)
    3. Neither provide nor assure (0)

    Core Panel: FAO

    • MCAD Medium-chain acyl-CoA dehydrogenase
    1. Provide testing (0.034)
    2. Assure testing (0.034)
    3. Neither provide nor assure (0)
  • VLCAD Very long-chain acyl-CoA dehydrogenase
    1. Provide testing (0.034)
    2. Assure testing (0.034)
    3. Neither provide nor assure (0)
  • LCHAD Long-chain L-3-hydroxyacyl-CoA dehydrogenase
    1. Provide testing (0.034)
    2. Assure testing (0.034)
    3. Neither provide nor assure (0)
  • TFP Trifunctional protein deficiency
    1. Provide testing (0.034)
    2. Assure testing (0.034)
    3. Neither provide nor assure (0)
  • CUD Carnitine uptake defect (Carnitine transport defect)
    1. Provide testing (0.034)
    2. Assure testing (0.034)
    3. Neither provide nor assure (0)

    Core Panel: AA

    • PKU Phenylketonuria/hyperphenylalaninemia
    1. Provide testing (0.034)
    2. Assure testing (0.034)
    3. Neither provide nor assure (0)
  • MSUD Maple syrup urine disease (branched-chain ketoacid dehydrogenase)
    1. Provide testing (0.034)
    2. Assure testing (0.034)
    3. Neither provide nor assure (0)
  • HCY Homocystinuria (cystathionine beta synthase)
    1. Provide testing (0.034)
    2. Assure testing (0.034)
    3. Neither provide nor assure (0)
  • CIT I Citrullinemia type I (Argininosuccinate synthetase)
    1. Provide testing (0.034)
    2. Assure testing (0.034)
    3. Neither provide nor assure (0)
  • ASA Argininosuccinate academia
    1. Provide testing (0.034)
    2. Assure testing (0.034)
    3. Neither provide nor assure (0)
  • TYR-1 Tryosinemia Type 1
    1. Provide testing (0.034)
    2. Assure testing (0.034)
    3. Neither provide nor assure (0)

    Core Panel: Hb Pathies

    • HB S/S Sickle cell disease
    1. Provide testing (0.034)
    2. Assure testing (0.034)
    3. Neither provide nor assure (0)
  • HB S/A S-Βeta thalassemia 1
    1. Provide testing (0.034)
    2. Assure testing (0.034)
    3. Neither provide nor assure (0)
  • HB S/C Sickle – C disease
    1. Provide testing (0.034)
    2. Assure testing (0.034)
    3. Neither provide nor assure (0)

    Core Panel: Others

    • CH Congenital hypothyroidism
    1. Provide testing (0.034)
    2. Assure testing (0.034)
    3. Neither provide nor assure (0)
  • BIO Biotinidase
    1. Provide testing (0.034)
    2. Assure testing (0.034)
    3. Neither provide nor assure (0)
  • CAH Congenital adrenal hyperplasia
    1. Provide testing (0.034)
    2. Assure testing (0.034)
    3. Neither provide nor assure (0)
  • GALT Transferase deficient galactosemia (Classical)
    1. Provide testing (0.034)
    2. Assure testing (0.034)
    3. Neither provide nor assure (0)
  • HEAR Hearing screening
    1. Provide testing (0.034)
    2. Assure testing (0.034)
    3. Neither provide nor assure (0)
  • CF Cystic Fibrosis
    1. Provide testing (0.034)
    2. Assure testing (0.034)
    3. Neither provide nor assure (0)
Data Collection Frequency: 
Biennial
Methodology Notes: 

    The Comprehensive Laboratory Services Survey (CLSS) is a biennial evaluation of 50 state public health laboratories and the District of Columbia public health laboratory in the provision of comprehensive laboratory services. (For this objective, the term “State” includes the District of Columbia.) Survey questions were developed by a workgroup of the Laboratory Systems and Standards Committee of the Association of Public Health Laboratories (APHL). The Committee consists of current and retired public health laboratory directors, members of academia, and other laboratory practitioners.

    In the list of questions used to obtain the baseline data, the point values shown after each response are used to score the questions. A laboratory is determined to provide or assure comprehensive laboratory services in support of the essential public health service if it scores at least 70% of the possible points. The data shown are the percent of state public health laboratories that score at least 70% of the possible points.

Caveats and Limitations: 
At this time, data for tribal agencies are not collected. However, if data should become available, the information will be included.
Trend Issues: 
Estimates from 2008 are based on DC and 48 states excluding ID and KS. 2010 estimates are based on 49 states excluding FL. DC did not participate in the 2010 survey. Estimates for 2012 are are based on 42 states and DC excluding AK, DE, MD, ND, NJ, SC, UT, and WA.

Revision History

Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

Description of Changes Since the Healthy People 2020 Launch: 
In 2013, the objective statement was revised so that it could "stand-alone" without the PHI-11 objective header. In 2014, the original baseline was revised from 88 percent to 90 percent to correct a calculation error. The target was adjusted from 97.0 percent to 99 percent to reflect the revised baseline using the original target-setting method.

References

Additional resources about the objective

  1. Association of Public Health Laboratories (APHL).