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State Surveillance Recommendations

Surveillance at the state level is essential for assessing the burden of arthritis, describing how arthritis affects various subpopulations, monitoring trends over time, and decision making for targeting interventions, allocating resources, and shaping state health policy. The following recommendations are intended to provide general direction and consistency for arthritis surveillance.

Strongly recommended

We encourage all states to participate in the following two surveillance activities:

  1. BRFSS—In odd years use these three sources: a) the "Arthritis Core" (Burden Questions), b) the optional "BRFSS Arthritis Optional Module (Management Questions), and c) Health-Related Quality Of Life (HRQOL). The Burden Questions and the HRQOL questions appear in the BRFSS core in odd-numbered years; states need to request that their BRFSS coordinator use the Arthritis Management Questions (arthritis optional module) and the HRQOL questions, which appear in an optional module in odd years (a rationale for including the Arthritis Management Questions (arthritis optional module) in odd years is available [DOC–92K]).

    CDC is not including either set of arthritis modules in even years. Thus, if a state wanted to use these questions in even years they would have to be included as special state added questions. In even years, we do not believe it is necessary to ask any arthritis questions unless you have a strong rationale for doing so (e.g., developing sub-state-level estimates).

    We recommend BRFSS arthritis data be analyzed for prevalence, health-related quality of life, limitations, behavioral arthritis risk factors (e.g., physical inactivity and obesity), interventions (e.g., taking an educational course), and by demographic groups (e.g., age, sex, race/ethnicity). A “state of arthritis report” should be prepared to disseminate the information every two years.
  2. Evidence-based interventions—Track the annual capacity to deliver evidence-based self- management interventions within the state and the number of participants reached by the interventions. Capacity measures the numbers of sites offering interventions and their geographic dispersion, courses offered, leaders offering interventions, and trainers offering trainings. Reach measures the number and characteristics of participants in the interventions. Evidence-based self-management interventions include interventions such as the Arthritis Foundation Exercise Program, EnhanceFitness, Walk with Ease, the Chronic Disease Self-Management Program, and Arthritis Self-Management Program.

Possible surveillance activities

The following surveillance data sources may be fruitful. However, states are discouraged from pursuing these activities unless there is a direct link to program activity and they are consistent with state arthritis plans:

  • Outpatient/ambulatory care data.
  • Data from managed care organizations.
  • Hospital discharge/joint replacement data.
  • Follow-back surveys of persons identified as having arthritis in BRFSS, other surveys, or other data sources. For example, data to gauge if state intervention programs are achieving the desired effects might include:
    • Awareness of signs and symptoms of arthritis and management options available.
    • Awareness of the need for early diagnosis and appropriate management.
    • Participation in arthritis self-management programs.
    • Early diagnosis and appropriate management of joint symptoms and arthritis.
    • Pain, disability, and quality of life among people with arthritis.
  • States can consider monitoring state trends in relevant Healthy People 2010 arthritis objectives by adding questions to the BRFSS (e.g., the optional BRFSS Arthritis Optional Module (Management Questions)), conducting special studies, or using NHIS Arthritis related questions (CAN 250_00.000 – CAN 297_00.010) [PDF–846K].

Not recommended

These surveillance activities are unlikely to help define the burden of arthritis in your state or assist in program activities, and should not be pursued unless there is a special and specific rationale for doing so.

  • Mortality data.
  • Medicaid data.
  • Pharmacy data.
  • Trauma registry or other injury data.
  • Workers’ Compensation or Social Security Income data.
  • Infectious disease surveillance data for gonorrhea or chlamydia.
  • Lyme disease surveillance data.

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