JMIR Publications

ABSTRACT

Background:

We aimed to quantify changes in internal data completeness following introduction of annual regional surveillance quality reports, and assess acceptability and perceived usefulness amongst CCAA.

Objective:

We aimed to quantify changes in internal data completeness following introduction of annual regional surveillance quality reports, and assess acceptability and perceived usefulness amongst CCAA.

Methods:

This mixed-methods evaluation consisted of two stages. First, we quantitatively assessed the internal completeness of 40 key TB variables all reported cases from 2018-2023, comparing two periods: before implementation of feedback reports (2018–2020) and after (2021–2023). Mean completeness for each variable was calculated for each period, and the differences compared using either the paired t-test or Wilcoxon signed rank test depending on whether differences were normally distributed. Analyses were conducted nationally and by CCAA, and for different variable groups (patient-, illness-, and laboratory-related). For the second stage, we circulated the results to regional TB surveillance focal points, along with a survey to assess acceptability, perceived usefulness of reports, and barriers to data completeness.

Results:

There were 25,299 reported cases across the study period, 13,328 in period 1 (2018-2020) and 11,901 in period 2 (2021-2023). Nationally, mean completeness increased from 66.0% in period 1 to 76.2% in period 2 (+10.2%, p<.001). Improvements were greatest for laboratory-related (+13.9%, p=.001) and illness-related variables (+12.8%, p<.001), while patient-related variables showed minimal change which was not statistically significant (+2.4%, p=.48). Most CCAA (84.2%, 16/19) demonstrated improved completeness in period 2, though substantial regional variation persisted. Of the 19 CCAA, 18 responded to the survey. Respondents reported high acceptability of the surveillance system and considered feedback reports useful. Challenges highlighted included resource constraints, system interoperability between laboratory and surveillance, and patient follow-up.

Conclusions:

Following introduction of annual feedback reports, which were well accepted by all regional stakeholders, Spain saw significant improvements in TB data completeness. Sustained feedback mechanisms, streamlined reporting requirements, and continued system integration are key to strengthening TB surveillance.