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Understanding the TB Cohort Review Process: Instruction Guide
2006
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Essential Element 3: Follow-up from a Cohort Review
The cohort review process does not end with case presentations
and a summary of outcomes. Each of the major participants must
bring the process full circle by applying information gained it
to improve treatment and contact investigation outcomes.
1. Timely Follow-Up of Identified Problems
Performing follow-up is an essential piece in the cohort review
process. Each participant has follow-up tasks to perform.
- Supervisors, nurses, and case managers will follow up
on case management suggestions made during the cohort review and
ensure that patients and contacts still on treatment finish treatment.
Because cohort reviews are held several months before the end
of the treatment year (from the time a case is reported to 365
days later), suggestions provided at a cohort review can allow
case managers to improve completion rates.
- The TB program manager will address programmatic
concerns and consider modifying staff training to address staff
learning needs.
- The data analyst or epidemiologist will update the registry
and prepare a summary report.
- The medical reviewer will address clinical and programmatic
problems that were noted and provide medical consultation.
Over time, the TB control program improves its outcomes through
a continual cycle of implementing, evaluating, and refining procedures
and processes.
The following page shows a sample Cohort Review Summary Report
from the data analyst to the members of the TB control team.
Sample Cohort Report Letter
City/State Department of Health
Tuberculosis Control Program
100 Main Street
Any City, Any State, USA
Dear TB Control Team Members,
Thank you for your participation in the first-quarter
cohort review session held October 15, 200_. The following
tables summarize the results:
Indices/Rates for TB Cases Counted 1/1 –
3/31
Index/Rate |
Quarter 1 Result |
Objective |
Index of completion at
time of cohort review |
65% |
60% |
Index of possible completion
at time of cohort review |
70.3% |
90% |
Index of likely to complete |
91.9% |
90% |
Death rate |
9.5% |
|
Default rate |
2.4% |
<2% |
Cohort failure rate |
4.8% |
<2% |
Indices for Contact Investigation—Counted
1/1 – 3/31
Index |
Quarter 1 Result |
Objective |
Contact index |
7 |
7 |
Smear-positive cases with
>0 contacts identified |
95% |
90% |
Contacts of smear-positive
cases evaluated |
90.1% |
95% |
Contacts of smear-positive
cases completed treatment |
21.7% |
85% |
The “Index of possible completion at time of
cohort review” fell short of our objectives; however, when
those likely to complete are added, we meet our objective.
We have a number of patients who have not yet completed treatment.
These patients need to be followed closely to ensure that
they complete within 365 days. We did not meet our objectives
for two of the indices for smear-positive patients. In order
to improve the percentage of contacts of smear-positive patients
who have completed treatment, we need to encourage them to
stay on treatment. I will report the final percentage for
contacts at the next cohort review after all the final data
on treatment completion are reported.
Our medical reviewer, Dr. Taylor, provided
the following suggestions to increase the completion rates:
- Pursue every option for DOT with the patient.
Get ideas from your team on how to keep your patients adherent
and on DOT.
- Always get cultures monthly until conversion
at 2 months and at completion of treatment to document conversion
and successful treatment.
- Keep tracking contacts, and make sure that
those infected are evaluated and those on treatment finish
treatment.
- When working with private providers, be
especially careful to get the names of contacts, obtain
smear and culture results, and ensure medication regimens
and dosages are correct.
Thank you for your continued hard work and
dedication. See you next quarter.
Sincerely,
Data Analyst
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Last Reviewed: 05/18/2008 Content Source: Division of Tuberculosis Elimination
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
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