Performance indicators for response to selected infectious disease outbreaks: a review of the published record

The purpose of this study was to determine whether published reports of infectious disease outbreaks could serve as a source of evidence for public health practice, particularly in responding to bioterrorism. Such performance indicators are measures of practice and process that lead to optimal health outcomes. We collected data from 116 individual articles that described 59 outbreaks of eight different pathogens with potential for bioterrorist use. Analysis of these reports determined whether they addressed 12 process indicators and four outcome indicators--each generally recognized as a component of effective outbreak response. The results showed that outbreak reports typically included information about these process and outcome indicators, thus validating their practical importance. However, few reports had been written with specificity to document the chronology of outbreak response, or the dissemination of information to protect healthcare workers, or the communication with law enforcement and emergency operations that are important in response to bioterrorism. We conclude that the published record of infectious disease outbreaks can, in the future, be used as a source for practice-based evidence if agreed-upon measures for effective performance become standard components of outbreak reports.