Metrics & monitoring

A checklist for establishing routine monitoring and assessment metrics of your contact tracing program

Checklist

1. Process indicators

• Identify key process indicators: (*key indicators)

  • Speed of contact tracing

    • *Percentage of new cases reported within 24 hours of specimen collection

    • *Percentage of cases interviewed and isolated within 24 hours of case report

    • *Percentage of contacts notified and quarantined within 24 hours of elicitation

    • Proportion of contacts with symptoms evaluated within 24 hours of onset of symptoms

  • Completeness of case investigation

    • Daily percentage of cases whose status has been monitored (i.e. checked for temperature, symptoms, and isolation status)

    • Proportion of cases with no contacts elicited

  • Completeness of contact tracing

    • Percentage of cases reached out of cases identified

    • Percentage of contacts reached out of contacts elicited from cases

    • Daily percentage of contacts whose status is monitored (i.e. checked for temperature, symptoms, and quarantine status)

  • Completeness of testing

    • *Of new symptomatic cases, number tested and interviewed within 3 days of onset of symptoms

    • Percentage of contacts connected to clinical care and/or testing out of those who develop symptoms

2. Outcome indicators

• Identify key outcome indicators: (*key indicators)

  • Overall

    • *Percentage of new cases arising among contacts identified by program and under quarantine at the time of onset of their symptoms or, if asymptomatic, at first positive test with immediate initiation of isolation. i.e., as proportion increases, it means we’re getting better at capturing and containing exposure before it spreads further

    • *Percentage of new cases unlinked to a source of infection

    • Number needed to interview: number of cases interviewed in order to result in one contact quarantined

  • Adherence to isolation or quarantine

    • Percentage of contacts who complete their full quarantine period

    • Percentage of cases who complete their full isolation period

MONITORING FOR IMPROVING ADHERENCE

• By tracking noncompliance rates and reasons, health departments can address challenges and improve compliance.

• Data collection should not have a negative impact on cases or contacts in isolation or quarantine. Their personal information should not be disseminated or published, except when imperative for public health purposes. This privacy also helps avoid stigmatizing individuals or groups.

3. Quality improvement and quality assurance indicators

• Identify key QI and QA indicators: (See Measures to Improve COVID-19 Response: End-to-End Quality Improvement of COVID-19 Testing, Case Investigation and Contact Tracing)

  • Data validity and completeness

  • Workforce recruitment, training and retention

4. Equity considerations in reporting

• Collect data for tracking and reporting on program equity. Ensure data is collected from cases and contacts in the contact tracing system to be able to stratify by relevant variables, such as:

  • Geography (county, city, neighborhood, ZIP code, or other meaningful geographic category)

  • Race/ethnicity

  • Age

  • Language preference

5. Dashboard

• Develop a dashboard aligned with IT system and consider how to align the dashboard with case reporting and case surveillance systems:

  • Key outcome and process indicators

  • Total and current cases by status (awaiting outreach; outreach underway; monitoring and support; closed)

    • By gender, age group, race/ethnicity

    • By county, neighborhood, ZIP code, or other meaningful geographic category

  • Reasons for closure of case (isolation completed; lost to follow-up; referred to local health department; hospitalized; declined; was never reached; died)

  • Median number of contacts per case (for cases with at least one contact)

    • Percentage by risk category (if risk categories are being used)

    • Percentage by type (individual case; mass gathering; group setting; facility with healthcare delivery)

  • Number/percentage of cases with no identifying information

  • Total and current contacts by status (awaiting outreach; outreach underway; monitoring and support; closed)

  • Reasons for closure of contacts (quarantine completed; lost to follow-up; referred to local health department; hospitalized; diagnosed with COVID-19; declined; was never reached; died)

  • Percentage of total and current contacts by risk level (if risk levels are being used)

  • Staffing indicators

    • Percentage of positions currently recruited, hired, onboarded, trained by title

    • Any performance standards, i.e. monitoring calls, etc.

  • Technology/digital app indicators and data flow indicators, depending on if and how technology is used

  • Telemedicine and connections to social support indicators

  • Communication and marketing indicators

6. Targets

• Set targets for key indicators, including timeliness of case and contact notification and quarantine, in order to guide adjustments to policies and protocols. (See COVID-19 Contact Tracing indicator list for consideration)

Implementation tools

• Measures to Improve COVID-19 Response: End-to-End Quality Improvement of COVID-19 Testing, Case Investigation and Contact Tracing

• Tracking COVID-19 in the United States: Progress and Opportunities

• COVID-19 Contact Tracing indicator list for consideration

• CDC ELC Performance Measures Guidance for Project E: Enhancing Detection

• Johns Hopkins University Bloomberg School of Public Health Contact Tracing Evaluation and Strategic Support Application (ConTESSA)

• Partners in Health Sample Contact Tracing KPI Dashboard

• Partnersin Health Initial Reflections: Dashboards and KPIs

• Massachusetts Community Tracing Collaborative: Why timing matters in the COVID-19 response

LIVING DOCUMENT This playbook is a dynamic, “living” document. Global knowledge pertaining to COVID-19 is rapidly evolving. Feedback and suggestions can be sent to [email protected].