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A Guide to Developing a TB Program Evaluation Plan

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Figure 3: Meta-model for TB Elimination

Goal: Eliminate TB in the United States.

A logic model is a graphic depiction of the program. This is the meta-logic model of the TB Elimination program. The arrows describe the links between inputs/resources, activities, outputs and outcomes.

Inputs/Resources

This section describes all of the resources available to implement your program. These include:

Capacity and infrastructure

  • Adequate funding
  • Strong and well-staffed programs
  • Functional data systems, including case management data system
  • Adequate physical, diagnostic, and treatment resources
  • Policies, procedures, and guidelines
  • Clinical, epidemiological, and operational research

Activities

Activities describe what your program is doing to accomplish objectives. These include:

Level 1:

Provide TB education and training to community providers

Find and treat active TB

  • Identify early
  • Use effective drugs
  • Reduce treatment barriers

Investigate Contacts

  • Identify contacts quickly
  • Locate and evaluate in a timely manner

Prevent TB in high-risk populations

  • Engage community partners
  • Detect LTBI & TB

Monitoring and evaluation

  • Data driven interventions to improve program activities defined & disseminated

Level 2:

Coordinate and communicate effectively with providers outside HD
Provide patient education and treatment
Patient on appropriate treatment; Patient adheres to treatment; Timely completion of appropriate treatment
Enhanced accountability

Outcomes

Outcomes are the intended effects of the program’s activities. They may or may not have been achieved by your program. They are the changes you want to occur in patients, providers, or the community, because of the work of your TB program. These are typically thought of as short-, mid- or long-term outcomes and should be tied to your program objectives.

Short/Mid-term Outcome:

  • Reduced TB transmission
  • Reduced LTBI prevalence
  • Reduced TB incidence
  • Reduced TB morbidity and mortality
  • Improved quality of patient life

Long-term Outcome:

  • Elimination of TB

Return to Guide to Writing TB Program Evaluation Plan Page

Worksheet 3: This worksheet shows the elements and the reorganization of an objective statement, “Increase percentage of adult patients with non-resistant TB who completed therapy (within 12 months) from 80% to 90% by 2007,” to form an indicator statement. Upon deletion of of the verb (increase), baseline measure (80%) and goal measure phases (90%) [as shaded in gray], the indicator statement reads: “Percent of adult patients with non-resistant TB who completed therapy (within 12 months) in 2007.”

Return to Guide to Writing TB Program Evaluation Plan Page

Appendix B: This table shows the break down of a SMART (specific, measurable, achievable, relevant and time-bound) objective statement into separate elements including a verb (increase), metric (percent), population (adult patients with non-resistant TB), object (completion of therapy - within 12 months), baseline measure (80%), goal measure (90%), and timeframe (by 2014).

Return to Guide to Writing TB Program Evaluation Appendix B Page

Meta-model for TB Elimination

Goal: Eliminate TB in the United States.

A logic model is a graphic depiction of the program. This is the meta-logic model of the TB Elimination program. The arrows describe the links between inputs/resources, activities, outputs and outcomes.

Inputs/Resources

This section describes all of the resources available to implement your program. These include:

Capacity and infrastructure

  • Adequate funding
  • Strong and well-staffed programs
  • Functional data systems, including case management data system
  • Adequate physical, diagnostic, and treatment resources
  • Policies, procedures, and guidelines
  • Clinical, epidemiological, and operational research

Activities

Activities describe what your program is doing to accomplish objectives. These include:

Level 1:

Provide TB education and training to community providers

Find and treat active TB

  • Identify early
  • Use effective drugs
  • Reduce treatment barriers

Investigate Contacts

  • Identify contacts quickly
  • Locate and evaluate in a timely manner

Prevent TB in high-risk populations

  • Engage community partners
  • Detect LTBI & TB

Monitoring and evaluation

  • Data driven interventions to improve program activities defined & disseminated

Level 2:

Coordinate and communicate effectively with providers outside HD
Provide patient education and treatment
Patient on appropriate treatment; Patient adheres to treatment; Timely completion of appropriate treatment
Enhanced accountability

Outcomes

Outcomes are the intended effects of the program’s activities. They may or may not have been achieved by your program. They are the changes you want to occur in patients, providers, or the community, because of the work of your TB program. These are typically thought of as short-, mid- or long-term outcomes and should be tied to your program objectives.

Short/Mid-term Outcome:

  • Reduced TB transmission
  • Reduced LTBI prevalence
  • Reduced TB incidence
  • Reduced TB morbidity and mortality
  • Improved quality of patient life

Long-term Outcome:

  • Elimination of TB

Return to Guide to Writing TB Program Evaluation Appendix C Page

I. Capacity and Infrastructure to Eliminate TB

Goal: Develop capacity and infrastructure for TB Elimination.

A logic model is a graphic depiction of the program. This is the logic model of Capacity and Infrastructure to Eliminate TB. The arrows describe the links between inputs/resources, activities, outputs and outcomes.

Inputs/Resources

This section describes all of the resources available to implement your program. These include:

  1. Burden of TB in the community
  • Existing partnership
  • National/state
    • State/local
    • HD/PMD
    • Community
  • Local
  • Existing oversight and state, local, and federal resources
  • Existing national TB surveillance system
  • Existing guidelines, laws, policies

Activities

Activities describe what your program is doing to accomplish objectives. These include:

Initial:

  1. Establish and maintain partnerships with community and congregate settings
    Establish linkages between
  2. Describe Burden of TB in community
  3. Identify target populations
  4. Establish goals and objectives
    Develop strategic plan

    Subsequent:

  5. Develop external communication systems and materials
  6. Advocate for resources internally and externally
  7. Determine related data elements, develop data definitions, and develop/ improve information reporting system
    Establish policies, procedures, and guidelines
    Develop internal communication systems and materials
  8. Develop staff organizational plan and job descriptions
    Recruit staff
    Provide staff development
  9. Provide strong supervisory and performance management system

Outcomes

Outcomes are the intended effects of the program’s activities. They may or may not have been achieved by your program. They are the changes you want to occur in patients, providers, or the community, because of the work of your TB program. These are typically thought of as short-, mid- or long-term outcomes and should be tied to your program objectives.

Short-term:

  1. Network of knowledgeable and engaged partners is created
  2. Adequate physical, diagnostic, treatment, and case management resources
  3. Strong patient tracking, management, and reporting systems are in place
  4. Pool of qualified, trained, and motivated staff exists
  5. Consistent expectations and accountability culture among staff and supervisors

Mid-term:

  1. Linkages ensure continuity of care
  2. Policies, procedures, and guidelines are implemented and adhered to.
    Strong and well-staffed programs are implemented that are consistent with strategic plan and demonstrate cultural competence.
    Systems provide ongoing and special data to allow for real time corrections and ongoing monitoring and reporting.

Long-term:

  1. Capacity to eliminate TB
  2. Efforts are continually improved based on evaluation and other findings

Return to Guide to Writing TB Program Evaluation Appendix C Page

II. Evaluation Capacity

Goal: Promote and enhance active program monitoring and self-evaluation among TB control partners at each administrative level.

A logic model is a graphic depiction of the program. This is the logic model of Evaluation Capacity. The arrows describe the links between inputs/resources, activities, outputs and outcomes.

Inputs/Resources

This section describes all of the resources available to implement your program. These include:

  1. Evaluation capacity:
    • Common ethos
    • Formal plan
    • Funds available
    • Roles defined
    • Multidisciplinary teams defined
    • Teams trained in evaluation theories, practice, methods
    • Ongoing training system
    • Evaluation planning and implementation processes
    • Common terminology (all on same page)
    • Standards for evaluation quality
    • Adequate data collection tools
    • Sufficient resources
  2.  
    1. Explicit, public, executive support for evaluation:
      • Top managers publicly promote evaluation
      • Resource decisions reflect support
      • Evaluation team and/or data users involved in key decisions
    2. Identifiable structures in place to promote evaluation use:
      • Resources to support changes indicated by evaluation results
      • Plans and mechanisms for dissemination of evaluation information
  3. 3. Existing data systems:
    • Standard data definitions
    • Standard data elements
    • Patient tracking system
    • Patient management systems
    • Criteria for data quality

Activities

Activities describe what your program is doing to accomplish objectives. These include:

  1. Train TB controllers and program managers
    Align incentives with expectations
    Identify and address barriers to evaluation
  2. Design good evaluations that adhere to good evaluation practices
  3. Collect additional data as needed for evaluation
  4. Collect routine surveillance and case management data (RVCT, ARPE, cases, contacts, LTBI, etc.)
    Analyze data:
    • Assess progress toward goals
    • Identify patterns
    Interpret data
    Monitor indicators and conduct performance measurement
  5. Disseminate evaluation findings and data systems findings

Outcomes

Outcomes are the intended effects of the program’s activities. They may or may not have been achieved by your program. They are the changes you want to occur in patients, providers, or the community, because of the work of your TB program. These are typically thought of as short-, mid- or long-term outcomes and should be tied to your program objectives.

Short-term:

  1. Advocates are created who have skill and desire and power to use data to improve program
    Learning culture
  2. Issues and service gaps identified
  3. Best interventions to close gaps are identified
  4. Data gaps and quality issues are identified
  5. Routine reports that are useful and valid

Mid-term:

  1. Data-driven best interventions and improvements are implemented
  2. Data-driven best interventions are disseminated

Long-term:

  1. Program efforts are improved
  2. Reduced incidence and prevalence of TB
  3. Elimination of TB
  4. Data and data systems are improved
  5. Enhanced accountability:
    • Efficient resource use
    • Demonstrated links between operations and outcomes

    Return to Guide to Writing TB Program Evaluation Appendix C Page

III. Timely Completion of Appropriate Treatment

Goal: Complete TB treatment among persons with TB disease within 12 months of diagnosis.

A logic model is a graphic depiction of the program. This is the logic model of Timely completion of appropriate treatment. The arrows describe the links between inputs/resources, activities, outputs and outcomes.

Inputs/Resources

This section describes all of the resources available to implement your program. These include:

  1. Adequate infrastructure:
    • Qualified, trained, and motivated staff
    • Community and congregate setting partnerships
    • Policies, procedures, and guidelines
    • Ongoing data collection, monitoring, and reporting systems
    • Adequate physical, diagnostic, treatment, field investigation, and case management resources
    • Linkages between jurisdictions
    • Adequate data collection tools
    • Legal authority to ensure adherence to treatment

Activities

Activities describe what your program is doing to accomplish objectives. These include:

  1. Educate community health care providers and administrators of congregate settings
    Engage in active case finding
    Conduct early patient medical assessment and diagnostic tests
    Conduct timely cultures and identify drug sensitivities
  2. Assess patient knowledge and social support
    Provide patient education and augmentation of social support system
    Collaborate on medical and case management
    Choose method and schedule of medication administration (DOT and/or SAT)
    Provide incentives and enablers
  3. Monitor patient for response to therapy and adverse drug effects
    Monitor patient for adherence to therapy
  4. Consult with TB expert physicians if necessary
  5. Isolate if necessary

Outcomes

Outcomes are the intended effects of the program’s activities. They may or may not have been achieved by your program. They are the changes you want to occur in patients, providers, or the community, because of the work of your TB program. These are typically thought of as short-, mid- or long-term outcomes and should be tied to your program objectives.

Short-term:

  1. Coordinated care in congregate settings
    Public and private MDs provide good care
    Good two-way communication between private MDs and local health department
  2. Cases identified and reported early
    Timely treatment start
    Drug resistance identified early
    Effective drugs identified early
  3. Treatment plan addresses both medical and social support needs
    Engaged patients
    Reduced barriers

Mid-term:

  1. Patient on appropriate treatment
  2. Patient adheres to treatment
  3. Patient non-adherent to treatment
  4. Appropriate Legal Action
  5. Patient responds to treatment
  6. Early end to infectious period
  7. Culture conversion

Long-term:

  1. Timely completion
  2. Prevention of development of drug resistance
  3. Cure
  4. Improved patient quality of life
  5. Reduced transmission of TB
  6. TB eliminated

Return to Guide to Writing TB Program Evaluation Appendix C Page

IV. Prevent TB in High Risk

Goal: Prevent TB among high-risk populations (through targeted testing and treatment).

A logic model is a graphic depiction of the program. This is the logic model of Prevention TB in High Risk. The arrows describe the links between inputs/resources, activities, outputs and outcomes.

Inputs/Resources

This section describes all of the resources available to implement your program. These include:

  1. Adequate infrastructure:
    • Qualified, trained, and motivated staff
    • Community and congregate setting partnerships
    • Policies, procedures, and guidelines
    • Ongoing data collection, monitoring, and reporting systems
    • Adequate physical, diagnostic, treatment, field investigation, and case management resources
    • Linkages between jurisdictions
    • Adequate data collection tools
    • Legal authority to ensure adherence to treatment

Activities

Activities describe what your program is doing to accomplish objectives. These include:

  1. Educate stakeholders
    Develop MOUs with community partners for diagnosis, treatment/referral, and coordination
  2. To identify:
    • Evaluate epi data to identify high-risk populations
    • Poll staff
    • Evaluate TLTBI data
    • Engage stakeholders (e.g., correctional facilities, drug treatment centers, CHCs, refugee service providers, homeless programs, immigration services, HIV testing, and care providers)
    Develop tool/protocol to prioritize high-risk groups based on evidence: epi data, recent outbreak investigations
    Identify appropriate staff
    Educate staff
  3. Educate patients
  4. Provide evaluation/TLTBI:
    • CXR
    • Medical evaluation
    • Case management
    • Monitoring
    • Incentives/enablers/ DOPT
  5. Monitor program yield

Outcomes

Outcomes are the intended effects of the program’s activities. They may or may not have been achieved by your program. They are the changes you want to occur in patients, providers, or the community, because of the work of your TB program. These are typically thought of as short-, mid- or long-term outcomes and should be tied to your program objectives.

Short-term:

  1. Good communication with community partners
    Community needs identified and understood
    Community partners adhere to guidelines
  2. Detection of LTBI
    People offered TLTBI
    People initiate TLTBI
  3. Evidence-based assessment of prevention effectiveness

Mid-term:

  1. Appropriate treatment
    Adherence (DOPT if needed)
    Timely completion of TLTBI
  2. Improved programs
    Services tailored to meet community needs
    More effective prevention

Long-term:

  1. Reduced TB incidence in high risk persons
  2. TB eliminated

Strategies: Identify and prioritize high risk persons; targeted testing and treatment for LTBI; develop partnerships with providers treating high risk groups

Note: Infection control is another strategy for preventing TB that will be addressed in another model

Notes: LTBI = latent TB infection; TLTBI = treatment for LTBI; DOPT = directly observed preventive therapy; CXR = chest X-ray; MOU = memorandum of understanding; CHC = community health center

Return to Guide to Writing TB Program Evaluation Appendix C Page

V. Contact Investigation

Goal: Prevent TB among contacts to cases (by finding and testing contacts for TB and LTBI, and then treating infected contacts to completion).

A logic model is a graphic depiction of the program. This is the logic model of Contact Investigation. The arrows describe the links between inputs/resources, activities, outputs and outcomes.

Inputs/Resources

This section describes all of the resources available to implement your program. These include:

  1. Adequate infrastructure:
    • Qualified, trained, and motivated staff
    • Community and congregate setting partnerships
    • Policies, procedures, and guidelines
    • Ongoing data collection, monitoring, and reporting systems
    • Adequate physical, diagnostic, and treatment resources
    • Linkages between jurisdictions
    • Adequate data collection tools
    • Partnership with private providers
  2. Comprehensive interview tool
    Staff trained in interview techniques
  3. Legal mandate to collect contact information from congregate settings

Activities

Activities describe what your program is doing to accomplish objectives. These include:

  1. Interview/reinterview cases:
    • Build rapport
    • Provide education
    • Obtain information about source case and contacts

    Locate and evaluate contact:
    • Follow-up
    • Education
    • Examination & testing*

    Offer treatment

    Treat contact – case management (DOT/DOPT/incentives)

  2. Reporting
  3. Monitor:
    • Data collection
    • Data management
    • Data analysis
    • Data dissemination
  4. Conduct periodic review of cases/contacts and progress toward contact treatment goals

Outcomes

Outcomes are the intended effects of the program’s activities. They may or may not have been achieved by your program. They are the changes you want to occur in patients, providers, or the community, because of the work of your TB program. These are typically thought of as short-, mid- or long-term outcomes and should be tied to your program objectives.

Short-term:

  1. Cases identify contacts
  2. Contacts educated
  3. Contacts evaluated
  4. Contacts followed up
  5. Contacts start treatment
  6. Evidence-based decisions about continuation or termination of contact investigation

Mid-term:

  1. Contacts complete appropriate treatment for active TB or LTBI
  2. Improved approaches for contact investigation

Long-term:

  1. Active TB cured in contacts
    TB (prevented)in contacts with LTBI
  2. Reduced incidence and prevalence of TB
  3. TB eliminated

Return to Guide to Writing TB Program Evaluation Appendix C Page

 
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