Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: May 25, 2026
Date Accepted: Jul 28, 2026
Performance of an Electronic Sentinel Surveillance System for Bacterial Gastroenteritis in South Korea: Mixed-Methods Evaluation Study
ABSTRACT
Background:
Bacterial gastroenteritis is a sizable public health burden worldwide. South Korea is no exception. In 2023, the disease made up half of all gastroenteritis cases notified to the Korea Disease Control and Prevention Agency (KDCA). For monitoring, the country has run an electronic sentinel surveillance system (SSS) since 2000, and 211 sentinel hospitals currently cover 11 bacterial gastroenteritis infections. Even so, the system has gone more than two decades without a comprehensive evaluation.
Objective:
We aimed to test, in three parts, how the South Korean electronic SSS for bacterial gastroenteritis is doing: its operational performance, its data quality, and how well its output agrees with nationwide National Health Insurance (NHI) medical claims data.
Methods:
This was a retrospective evaluation. Three data streams fed the analysis: a semi-structured survey sent to all 211 sentinel hospitals between July and August 2024; a structured interview with the KDCA operator responsible for routine system operation; and NHI medical claims data covering the entire Korean population for 2021 and 2023. We applied the KDCA evaluation framework, itself adapted from the US Centers for Disease Control and Prevention (CDC) guidelines, to assess simplicity, acceptability, timeliness, completeness, claims-based concordance as a proxy for sensitivity, and representativeness. Pearson correlation coefficients quantified concordance with NHI claims and age-based and geographical representativeness.
Results:
Of the 211 sentinel hospitals invited, 180 returned completed questionnaires (response rate 81.8%). Of these, 90.0% rated the reporting process as simple or adequate; 83.8% rated overall satisfaction as neutral or good. The delayed reporting proportion fell from 2.4% in 2021 to 1.1% in 2023, with on-time completeness at 98.4%. The Pearson correlation between SSS-reported cases and NHI claims was 0.937 in 2023, up from 0.899 in 2021. For age-based representativeness, the 0–6 year group showed the strongest agreement (0.969 in 2021 and 0.982 in 2023; both P < .001). Geographical allocation representativeness correlations were 0.946 (2021) and 0.951 (2023; P < .001).
Conclusions:
South Korea’s electronic SSS for bacterial gastroenteritis works well on simplicity, timeliness, and on-time completeness, and its output agrees closely with nationwide NHI claims. Two areas still need attention: acceptability at sentinel hospitals, and structured training for KDCA operators. Looking ahead, periodically triangulating electronic sentinel reports with administrative claims data offers a low-burden way to keep an eye on reporting consistency, representativeness, and possible underreporting. The Korean experience may also be useful to other countries setting up similar systems. Clinical Trial: N/A
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