Understanding the TB Cohort Review Process: Instruction Guide (2006)
The purpose of this document is to describe the cohort review process. The cohort review process has proven to be a very useful tool for ensuring accountability, educating staff about protocols and objectives, and improving case management and prevention. It is a management process that will motivate staff, reveal programs’ 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.
Cohort review is a systematic review of the management of patients with TB disease and their contacts. A “cohort” is a group of TB cases counted over a specific period of time, usually 3 months. The cases are reviewed approximately 6–9 months after they are counted; therefore, many of the patients have completed treatment or are nearing the end of treatment. Details regarding the management and outcomes of TB cases are reviewed in a group setting. 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.
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.
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 made by the TB control team during 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.
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.
“Cohort review can be an important means of increasing your completion rate, of tracking your contact index, of seeing how well you are doing with contact elicitation and starting contacts on treatment; so every aspect of a TB program can be tracked through this. Basically it is a management tool. It is a management tool that says we care about every single patient…”
Thomas Frieden, MD, MPH, New York City Commissioner of Health