1. Bevc, Christine A. PhD, MA
  2. Markiewicz, Milissa L. MPH, MIA
  3. Hegle, Jennifer MPH
  4. Horney, Jennifer A. PhD, MPH
  5. MacDonald, Pia D. M. PhD, MPH


Context: The North Carolina Division of Public Health established an innovative program in 2003 that placed public health epidemiologists (PHEs) in hospitals around the state to improve communication between hospitals and local public health departments (LHDs) and bolster public health surveillance and response.


Objective: To use social network analysis to assess how the hospital-based PHE program in North Carolina facilitates the exchange of public health surveillance information.


Design: Using a Gould-Fernandez brokerage analysis, this study examines communication among organizational actors and their dependence on third parties to broker information and knowledge.


Participants: Survey and interview data were collected to identify the interorganizational network among 220 organizational actors and their public health surveillance-related activities, including 11 PHEs, 100 county-level offices of North Carolina's 85 LHDs, and 109 hospitals.


Main Outcome Measures: Social network analysis is used to calculate the frequency with which an actor serves as an intermediary in each of the 5 brokerage roles as well as total brokerage equal to the sum of the number of times an actor occupies each role.


Results: Results identify a frequent tendency for PHEs to serve as an intermediary between LHDs and hospitals. Interactions between these entities are frequently facilitated by PHEs, with a high measure of degree centrality by LHDs and a low frequency of brokerage among hospitals.


Conclusions: Results validate PHEs' mission to enhance communication between LHDs and hospitals around communicable disease surveillance, reporting, and management.