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

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What Is the Cohort Review Method?

4.  Essential Elements of the Cohort Review Process

TB programs across the country have adopted a variety of approaches to conducting cohort reviews.  All of the approaches incorporate the same key elements of preparation, presentation, and follow-up.

Cohort Review Process: Preparation, Presentation, Follow-up.

Preparation encompasses developing program objectives, ensuring that sound case management protocols are in place, using a reliable TB registry, and carefully preparing the case. 

The element of presentation includes using a standardized format for cohort reviews, providing TB case and contact information to the TB control team, and presenting immediate feedback on goal accomplishment. 

Follow-up involves acting on the recommendations of the TB control team from the cohort review session, ensuring that those patients and contacts started on treatment complete treatment, and following up on programmatic issues (e.g., training) that were noted at the cohort review session.  Using this process allows TB programs to improve outcomes through a continual cycle of learning.

 “I see the cohort review as an educational experience.  I learn what it is that staff are doing, it tells me what are the issues that are there for every patient, what are the barriers that staff face, and all of the things that they accomplish…”

Sonal Munsiff, MD, Director, Bureau of TB Control,
New York City Department of Health and Mental Hygiene

The following table lists the elements associated with the preparation, conduct, and follow-up in a cohort review process.  It is designed so that your TB program may conduct an at-a-glance assessment of its readiness to conduct cohort reviews, and it provides an overview of what may need to be enhanced in order for you to implement the cohort review approach.

Exercise 1:  TB Program Self Assessment
Essential Elements of the Cohort Review Process
What are you already doing? YES NO What may need to be enhanced in order for you to conduct a cohort review:
1.  Preparation
  • Ensuring that TB program staff know TB program objectives
    
  • Delineate national, state, and local objectives for your program
  • Communicate these objectives to all TB program staff
  • Using a comprehensive case management system
    
  • Ensure that case management protocols are clearly written, comprehensive, and practical for staff to implement
  • Using a reliable TB registry
    
  • Specify data elements that need to be collected to evaluate program objectives
  • Ensure that staff update registry information regularly
  • Use the registry to generate cohort lists for TB control team members
  • Carefully preparing cases for presentation
    
  • Use periodic case reviews to ensure that case and contact information needed for the cohort review is collected
  • Consider adding practice sessions to hone case presentation skills
  • Implement a standard form and presentation format to ensure consistent, concise, and complete presentations

2.  Presentation
  • Presenting each case in detail to the TB control team
    
  • Allow team members sufficient time to analyze and evaluate TB cases and contact investigations
  • Providing on-the-spot feedback to staff, troubleshooting, and aggregate reporting
   
  • Allow time for troubleshooting of case management issues
  • Develop a standard format for aggregate reporting of data

3.  Follow-up
  • Following up on noted problems
   
  • Team members use information gathered at cohort review to follow up on cases and contact investigations, address staff training issues, and solve programmatic problems

These elements of cohort review will be detailed in the next chapters.


 
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