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

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What Is the Cohort Review Method?

2. Roles of the TB Control Team

Tuberculosis control teams throughout the United States are composed of health professionals with many different job titles and roles. Urban, high-incidence areas may have a unit large enough to be divided into specific functional teams. In contrast, rural or low-incidence areas may have only a few staff who manage the entire TB program. For the purpose of outlining the cohort review approach, we will highlight five functional roles for TB control team members: TB program manager, medical reviewer, data analyst, supervisor, and case manager. It is important to note that although the roles have been given “position titles,” these may be different in some settings. Depending on the size and make-up of the TB control team, members might also play multiple cohort review roles. In reading this section, one should focus on the functions for each of the team members rather than the specific position title.

The sample organizational chart below reflects the possible interrelationship of team members.

Tb program manager > Data analyst > medical reviewer > supervisor > case manager > outreach Staff > DOT Staff > Community Providers. TB control cohort review team members. TB Control Staff & Community providers.

At first glance, a cohort review presentation may seem to be only a presentation of outcomes of TB case management activities. In reality, the cohort review presentation is the culmination of a long process that begins the day the case is reported, far in advance of the presentation day. The following tables highlight the specific roles of members of the TB control team in preparing for and conducting a cohort review. These roles will be explored in more detail as each element of the cohort review process is explained.

Table 3: Role of the TB Program Manager

TB Program Manager

Preparation for a cohort review

  • Demonstrate commitment to the cohort review process.
  • Ensure staff at all levels understand the reasons for undertaking cohort reviews.
  • Ensure staff at all levels have the knowledge and skills needed to perform the tasks required.

Cohort review presentation

  • Listen to all case presentations.
  • Ask questions of clarification to ensure that all aspects of case management adhere to department of health policies and procedures.
  • Use teachable moments to illustrate important lessons in effective TB control.

Follow-up after cohort review

  • Ensure that medical management and other issues are addressed.
  • Ensure that ongoing, follow-up staff education incorporates program strengths and weaknesses.

Table 4: Role of the Medical Reviewer

Medical Reviewer
Preparation for a cohort review
  • Demonstrate commitment to the cohort review process.
  • Ensure staff at all levels understand the reasons for undertaking cohort reviews.

Cohort review presentation

  • Listen carefully to all case presentations and review available support documents (e.g., printouts from TB registry, charts, and medical records).
  • Ensure that all aspects of case management adhere to department of health policies and procedures. This includes ensuring that

– Activities are completed in a timely manner

– Data are complete (e.g., date of birth, entry to US, HIV status)

– Drug regimen is appropriate (e.g., probe for explanations for nonstandard regimens)

– Susceptibility results are obtained, drug regimen adjusted if necessary

– Sputum conversion and completion of treatment are documented

– Contact investigation activities and outcomes are assessed

  • Ask questions of clarification to make sure policies and procedures were followed and the outcome is satisfactory.
  • Use teachable moments to illustrate important lessons in effective TB control.

Follow-up after cohort review

  • Ensure that medical management issues are addressed.
  • Ensure that ongoing, follow-up staff education incorporates program strengths and weaknesses.

Table 5: Role of the Data Analyst

Data Analyst

Preparation for a cohort review

  • Prepare lists of cases to be reviewed ahead of time: preliminary cohort list 5 months before cohort review, final cohort list 2 months before cohort review.
  • Distribute the lists to case managers and supervisors so they can be prepared to present these cases.
  • Enter relevant information on each case and contact on the cohort summary sheet.
  • Prepare a summary of the current cohort to present at the review session.
  • Calculate the outcomes of previous cohort patients who were likely to complete and contacts who were still on treatment for LTBI.

Cohort review presentation

  • Present summary of the current cohort of cases.
  • Record data on treatment outcomes and other missing information, while the case managers present each case. Note any issues for clarification.
  • Tabulate or calculate the treatment outcomes for cases and contacts; present this at the end of the cohort review session.

Follow-up after cohort review

  • Write a report of the cohort review outcomes and distribute it to everyone who has a need to know.

Table 6: Role of the Case Manager

Case Manager

Preparation for a cohort review

  • Follow all protocols for case management to ensure that patients adhere to treatment, comply with medical visits, and complete treatment.
  • Follow all protocols for contact investigation to ensure that contacts are identified and evaluated, and that they complete treatment for LTBI, if appropriate.
  • Communicate periodically with clinic and outreach workers to ensure everything is proceeding without problems; troubleshoot problems.
  • Participate in case review meetings with your supervisor and case conference meetings with your TB control team as these are scheduled.
  • Ensure a complete job had been done (e.g., all loose ends are tied up, all details are considered, and you have information to answer any questions).
  • Prepare a concise presentation of the case according to a standard format.
  • Participate in a mock cohort review session to practice your presentation and become accustomed to handling questions that might arise (optional).

Cohort review presentation

  • When the TB program manager calls one of your cases, speak loudly and clearly as you deliver your concise presentation.
  • Answer questions from the TB program manager, medical reviewer, data analyst, or other TB team members.
  • Ask any questions you may have about patient care issues.
  • Ask your fellow caseworkers and supervisor to provide any information relevant to your case presentation if necessary.
  • Follow-up after cohort review
  • Follow up to obtain any missing information or clarify details that were noted during the cohort review.
  • Update TB registry information as needed.
  • Meet with your supervisor to discuss what went well and what could be improved for the next cohort review in 3 months.
  • Continue case management if patient has not completed treatment; continue contact investigation activities until contacts who should start or complete LTBI treatment have done so.

Table 7: Role of the Supervisor

Supervisor

Preparation for a cohort review

  • Supervise and assist your case management and contact investigation staff in following protocols.
  • Hold one-on-one case review meetings with each staff member.
  • Hold periodic case conference meetings with your entire team.
  • Troubleshoot problems with staff.
  • Make sure staff prepare a concise presentation of the case according to a standard format.
  • Hold a mock cohort review session for staff to practice presentation skills. Ask them the kinds of questions that might arise in a real cohort review.
  • Cohort review presentation
  • Let staff members speak for themselves.
  • Only add something if more detail or confirmation of the approach or activities is required.

Follow-up after cohort review

  • Follow up to ensure staff obtain missing information, clarify details, and update TB registry information, as noted during the cohort review.
  • Meet with staff as soon as possible to discuss what went well and what could be improved for the next cohort review in 3 months.

 
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  • Page last updated: September 1, 2012
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