Understanding the TB Cohort Review Process: Instruction Guide (2006)
|DEPARTMENT OF HEALTH & HUMAN SERVICES
Public Health Service
The 2000 Institute of Medicine report Ending Neglect: The Elimination of Tuberculosis in the United States concluded that tuberculosis (TB) elimination is feasible, but will require “aggressive and decisive action beyond what is now in effect.” The report recommended adopting an aggressive strategy in order to maintain control and ensure the most efficient application of resources. To this end, TB control programs must develop new standards by which to monitor and evaluate program performance.
One such evaluation method is cohort review, a systematic review of patients with TB disease and their contacts. This method, used in countries around the world and in several programs in the United States, examines a group or “cohort” of patients from a specific period of time in terms of individual patient outcomes and overall program performance.
The cohort review process has proven to be a very useful tool for ensuring accountability, educating staff about protocols and goals, and improving case management and prevention. Case managers and other staff know that their day-to-day efforts will be reflected in the cohort review several months later and that they are accountable for the services they provide. They are responsible for ensuring that patients who are started on treatment finish treatment. As a result, patients are less likely to “fall between the cracks” and receive inadequate care. Since 1993, when the cohort reviews began in New York City, the treatment completion rate there has increased from less than 50% to 93%.
You may already conduct administrative reviews of TB cases and contacts. The cohort review method builds upon many current practices, but adds a quantitative difference to program review and examination of treatment outcomes. It is a management process that will motivate staff, reveal program strengths and weaknesses, indicate staff training and professional education needs, increase staff accountability for completion of treatment for both TB disease and latent TB infection (LTBI), and improve TB case management and the identification of contacts.
Admittedly, adopting the cohort review methodology is a challenging undertaking. As with any change in management approach, there will be bumps in the road, and the positive results may not be immediately evident. Successful implementation requires an ongoing commitment to adopting this management approach, tailoring it to fit local needs, training and motivating staff, and following up on noted problems.
To assist you in learning and applying the cohort review method, a team from the Centers for Disease Control and Prevention and the Charles P. Felton National Tuberculosis Center at Harlem Hospital have developed the attached instruction guide. We believe it provides an excellent starting point for program areas in implementing the cohort review methodology.
I wish you success in adapting this methodology in your program area. Improved program evaluation data will allow you to efficiently apply your program resources and maintain TB control—the first steps toward eliminating tuberculosis.
Kenneth G. Castro, M.D.
Assistant Surgeon General
Division of Tuberculosis Elimination
National Center for HIV, STD, and TB Prevention