TB Notes Newsletter
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No. 4, 2006
Surveillance, Epidemiology, and
Outbreak Investigations Branch Update
9th Semiannual Meeting of the Tuberculosis
Epidemiologic Studies Consortium
The 9th Semiannual Meeting of the
Tuberculosis
Epidemiologic Studies Consortium (TBESC) convened July
12–13, 2006, in Atlanta, Georgia. The primary purpose of
the TBESC is to conduct epidemiologic, behavioral,
economic, laboratory, and operational research in TB
prevention and control.
The goal of the meeting was to update consortium
members on the status of research projects, discuss and
refine the process by which research proposals are
submitted and reviewed, and discuss the latest study on
new diagnostic tests for detecting latent TB infection.
Over 90 persons participated in the meeting. Attendees
included CDC staff, consortium principal investigators,
project coordinators, and project specific personnel.
Participants heard presentations from CDC, TBESC
members, and invited guests on a broad array of topics
that included-
- Scientific updates from TBESC studies with new
research results
- Administrative and fiscal updates on
consortium-related activities
- Updates from the Bylaws and External Relations
Committees, and the Translating Research into
Practice Workgroup
- The epidemiologic basis of TB control
Participants discussed modifying the process by which
consortium research proposals are submitted, reviewed,
and awarded, and reexamined the research agenda focus,
goals, and research questions. The meeting was
productive and responsive to the mission of the TBESC.
—Reported by Christopher J. Kissler,
MPH
Div of TB Elimination and
TBESC External Relations Committee
TBESC Task Order #10: Monitoring Performance and
Measuring Cost of Tuberculosis Public Health Practice at
County and State Health Departments:
Are We Making a Health Impact?
In the past, TB public health evaluation focused on
two questions:
- Are we headed in the right direction
(objectives)? and
- Are we making efficient progress (performance)?
These two questions are usually asked of TB case
management, contact investigation, targeted testing, and
outbreak investigation (action). However, for the most
part, these questions ignore TB case detection,
registration, and analysis (surveillance). Further, the
question of effectiveness is unasked, and often, local
and state TB programs remain unaware of missed
opportunities to improve both efficiency and
effectiveness. Further, the limited evaluation efforts
that currently exist focus mainly on monitoring, with
little to no in-depth evaluation, which is required to
know where and how to intervene in response to poor
performance. While objectives are established, programs
have few tools to monitor and evaluate progress toward
them in a user-friendly, Web-based, real-time manner.
Other evaluation areas remain problematic for TB
managers. Program costs come to the manager in the form
of line items (e.g., personnel, travel, or equipment).
This does not allow costs to be translated into specific
public health activities. For example, a program manager
cannot answer the simple question, how much does it cost
to perform case management or outbreak investigation?
This is because cost data are not passed through what
might be called an “interpretive grid” into specific
public health activities. Often intuitive rather than
data-driven decisions are made by program managers. Cost
is important to program, but is not generally considered
for evaluation. In recent years, TB budgets have shrunk,
challenging programs to do the same or more with less
money. Knowing the cost involved in running a successful
TB program that achieves health impacts is crucial,
especially in the face of shrinking budgets. Programs
should and must be able to ask and answer questions such
as, what is the cost of each program activity, such as
case finding or case management? In what areas of my
program is the most money spent?
Task Order #10’s vision was to develop tools that
will facilitate quick, user-friendly monitoring and
evaluation as a way to help TB programs target
interventions toward cost efficiency and improved
performance. The goal was to develop and implement
simple, standardized, Internet-based tools for TB
programs that can be used to monitor performance and
measure costs. Task Order #10 achieved this goal. The
Florida Department of Health (FL DOH) and the University
of North Texas Health Science Center conducted this
operational research and developed two tools. These two
simple, standardized, yet customizable tools are based
on an action-led conceptual framework that includes
eight core activities (detection, registration,
reporting, confirmation, analysis, feedback, acute
response, and planned response) and four support
activities (communication, training, supervision, and
resource provision).
In phase I, we collected program indicators from a
variety of national, state, and local programs. We
compiled these indicators in a database totaling over
150 indicators mapped to the conceptual framework. Task
Order #10 sites held focus groups at multiple locations
with various levels of public health professionals
ranging from nurses to program managers, to determine
which indicators were the most useful. Group
participants evaluated the indicators based on
importance, understandability, utility, availability,
measurability, and cost effectiveness. In phase II, we
continued to collect and analyze evaluation data from
additional counties or regions at the two project sites.
In addition, the Task Order #10 teams began the process
of costing TB activities using the conceptual framework.
In phase III, we developed and refined the two tools.
The Florida Public Health Impact Tool (PHIT) assists
TB control programs in monitoring performance,
evaluating established objectives, examining related
costs, and measuring the health impact of their
interventions. PHIT uses data readily available to TB
programs to calculate the costs associated with
performance measures. These calculations can focus on
specific program areas such as surveillance or contact
investigation, look at program areas over time, and
compare across programs. By linking the cost to
performance outcomes, PHIT provides meaningful
information that will help managers highlight program
accomplishments or investigate areas that need
attention. These evaluation findings provide useful data
for improving TB programs and advocating for resources.
Texas’ Tuberculosis Program Economic Decision Support
tool (TB EDS) can be used to assist TB control programs
in modeling the effect of changes in local conditions.
TB EDS can be used to estimate the resources required to
achieve a level of performance and predict the
additional resources needed to meet changing conditions.
The ability to model the effect of changing conditions
on performance enables managers to maximize resources
and increase program efficiency. TB EDS can also be used
to guide program staff in budget preparation,
contingency planning, and comparisons of alternative
program components or technologies.
 |
| The Task Order # 10 team at the University
of North Texas Health Science Center campus
during the Second Annual Health Economic
conference, October 2005. |
The funding for Task Order
#10 ends on September 30, 2006, but our work will
continue. Three peer-reviewed manuscripts have been
published, and five manuscripts are in preparation. Over
our 3-year project, 28 abstracts have been presented at
various meetings, including the National TB Controllers
Association and American Evaluation Association. We have
given numerous oral presentations including seven
Division Brown Bag seminars. Two Economic Health Forums
supported by Task Order #10 were held on the campus of
the University of North Texas Health Science Center in
2004 and 2005. For a copy of our bibliography, a
description of Task Order #10 tools, or copies of the
tools themselves, please contact Bridget Young at
bjy0@cdc.gov.
—Submitted by Bridget Young
Div of TB Elimination |
