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Understanding the TB Cohort Review Process: Instruction Guide (2006)

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Essential Element 3: Follow-up from a Cohort Review

The cohort review process does not end with case presentations and a summary of outcomes. Each of the major participants must bring the process full circle by applying information gained it to improve treatment and contact investigation outcomes.

Cohort Review Process: Preparation, Presentation, Follow-up: 1. Timely follow-up of Identified Problems

1. Timely Follow-Up of Identified Problems

Performing follow-up is an essential piece in the cohort review process. Each participant has follow-up tasks to perform.

  • Supervisors, nurses, and case managers will follow up on case management suggestions made during the cohort review and ensure that patients and contacts still on treatment finish treatment. Because cohort reviews are held several months before the end of the treatment year (from the time a case is reported to 365 days later), suggestions provided at a cohort review can allow case managers to improve completion rates.
  • The TB program manager will address programmatic concerns and consider modifying staff training to address staff learning needs.
  • The data analyst or epidemiologist will update the registry and prepare a summary report.
  • The medical reviewer will address clinical and programmatic problems that were noted and provide medical consultation.

Over time, the TB control program improves its outcomes through a continual cycle of implementing, evaluating, and refining procedures and processes.

The following page shows a sample Cohort Review Summary Report from the data analyst to the members of the TB control team.

Sample Cohort Report Letter

City/State Department of Health
Tuberculosis Control Program
100 Main Street
Any City, Any State, USA

Dear TB Control Team Members,

Thank you for your participation in the first-quarter cohort review session held October 15, 200_. The following tables summarize the results:

Indices/Rates for TB Cases Counted 1/1 – 3/31

Index/Rate

Quarter 1 Result

Objective

Index of completion at time of cohort review

65%

60%

Index of possible completion at time of cohort review

70.3%

90%

Index of likely to complete

91.9%

90%

Death rate

9.5%

 

Default rate

2.4%

<2%

Cohort failure rate

4.8%

<2%

Indices for Contact Investigation—Counted 1/1 – 3/31

Index

Quarter 1 Result

Objective

Contact index

7

7

Smear-positive cases with >0 contacts identified

95%

90%

Contacts of smear-positive cases evaluated

90.1%

95%

Contacts of smear-positive cases completed treatment

21.7%

85%

The “Index of possible completion at time of cohort review” fell short of our objectives; however, when those likely to complete are added, we meet our objective. We have a number of patients who have not yet completed treatment. These patients need to be followed closely to ensure that they complete within 365 days. We did not meet our objectives for two of the indices for smear-positive patients. In order to improve the percentage of contacts of smear-positive patients who have completed treatment, we need to encourage them to stay on treatment. I will report the final percentage for contacts at the next cohort review after all the final data on treatment completion are reported.

Our medical reviewer, Dr. Taylor, provided the following suggestions to increase the completion rates:

  • Pursue every option for DOT with the patient. Get ideas from your team on how to keep your patients adherent and on DOT.
     
  • Always get cultures monthly until conversion at 2 months and at completion of treatment to document conversion and successful treatment.
     
  • Keep tracking contacts, and make sure that those infected are evaluated and those on treatment finish treatment.
     
  • When working with private providers, be especially careful to get the names of contacts, obtain smear and culture results, and ensure medication regimens and dosages are correct.

Thank you for your continued hard work and dedication. See you next quarter.

Sincerely,
Data Analyst


 
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