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The Status of TB Prevention and Control Measures in Large City and County Jails in the U.S.

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Executive Summary

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Strengthen TB Information Systems and Program Assessment

Strengthen TB Information Systems and Program Assessment
In general, most of the jail systems in the study had inadequate medical information systems, which are essential for case management and program assessment. In addition, most jail systems conducted only limited assessments of the effectiveness of their TB control efforts.

Specific Recommendations

  • Improve the completeness of medical records data. Of the medical records examined for inmates evaluated for TB disease, only a quarter contained complete documentation of pertinent clinical procedures, results, and dates for TB screening, diagnosis, and treatment. This information is necessary both for individual case management and overall program management and assessment.
  • Develop aggregate record-keeping systems for TB-related data. Over one third of the jail systems did not have any aggregate record-keeping systems (paper-based or electronic) for tracking inmates and assessing their TB treatment status. Only 15 percent had electronic record-keeping systems. The resulting data limitations hampered TB program monitoring and assessment.
  • Conduct periodic review of TB trend data and chest radiograph results. Half of the jail systems reported monitoring trends in inmates’ tuberculin skin test (TST) results and the proportion that have a positive test. Periodic review of skin-test result data is important to determine how widespread LTBI is in the inmate population, to monitor TB risk, and to follow trends over time.
  • Implement TB program quality improvement procedures. Less than one third of the jail systems conducted periodic assessments of their TB prevention and control programs through records review. Review of records of inmates with TB disease and infection can highlight operational barriers to TB control efforts and is important for assessing the adequacy of TB policies and procedures.


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