|
|
|
|||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||
Understanding the TB Cohort Review Process: Instruction Guide 2006What Is the Cohort Review Method?Cohort review has been an integral part of the TB control approach
advocated by the International Union Against Tuberculosis and Lung
Disease (IUATLD). Dr. Karel Styblo, who pioneered the approach in
The cohort review process can take many forms. In its most simplified form, TB control staff at the local level meet to review the treatment outcomes of every patient listed in a chronological patient register. Today, with computerized TB registries, multimedia projection, and cheaper long-distance communications, it can be adapted to a variety of settings. “The fundamental concept of a cohort review is accountability. Staff are accountable to supervisors and to the program for how well they are caring for patients...and the program is accountable to patients and to the public for controlling tuberculosis.” Thomas Frieden, MD, MPH, New York City Commissioner of Health 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 with the following information presented on each case by the case manager:
All TB patients should be assigned a case manager, whether they receive TB care in one of the health department clinics or from a private provider. During the cohort review, case managers present the TB cases for which they are responsible, often assisted by staff involved in contact investigation, directly observed therapy, and initial patient evaluation. TB case managers know that their day-to-day case management efforts will be reflected in the cohort review several months later and that they are accountable for the services they provide. Information reported on each case at the cohort review session is found in Table 1. Table 1: Case Information Reported in a Cohort Review
The presentation of cases allows staff to detect potential problems in the way the case is being managed, such as the use of an inappropriate regimen or an inadequate number of contacts tested. It also allows clinicians, managers, and public health advisors to consult on difficult cases, especially those in which the patient is nonadherent, has MDR TB, or has numerous contacts in a congregate setting. Finally, it allows senior staff and managers to recognize the intensive efforts of staff in managing TB cases and contacts. Overall, the cohort review process can benefit the TB program by
After you have read this guide and completed the exercises, you will be able to
The document is organized into the following sections:
Many of the tools and processes in this guide are modeled on the highly successful program at the New York City Department of Health and Mental Hygiene, Bureau of Tuberculosis Control (BTBC). It is recognized that each program area is different, in its TB epidemiology as well as in its TB control and prevention efforts. It is not true that one size fits all. However, in any setting the principles of systematic review and accountability that are fostered by the cohort review method can help improve overall program performance. Last Reviewed: 05/18/2008 |
||
|
If you would like to order any of the DTBE publications please visit the online order form. You will need Adobe Acrobat™ Reader v5.0 or higher to read pages that are in PDF format. Download the Adobe Acrobat™ Reader. If you have difficulty accessing any material on the DTBE Web site because of a disability, please contact us in writing or via telephone and we will work with you to make the information available. Division of Tuberculosis Elimination
Centers for Disease Control & Prevention |