Understanding the TB Cohort Review Process: Instruction Guide
2006
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Adopting Cohort Review: It Can Make
a Difference
Letter from Director of CDC’s Division
of Tuberculosis Elimination
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DEPARTMENT OF HEALTH & HUMAN
SERVICES Public Health Service
Centers for Disease Control
and Prevention (CDC)
Atlanta, GA 30333 |
Dear Colleague:
The 2000 Institute of Medicine report Ending Neglect: The Elimination
of Tuberculosis in the United States concluded that tuberculosis
(TB) elimination is feasible, but will require “aggressive and decisive
action beyond what is now in effect.” The report recommended
adopting an aggressive strategy in order to maintain control and
ensure the most efficient application of resources. To this
end, TB control programs must develop new standards by which to
monitor and evaluate program performance.
One such evaluation method is cohort review, a systematic review
of patients with TB disease and their contacts. This method,
used in countries around the world and in several programs in the
United States, examines a group or “cohort” of patients from a specific
period of time in terms of individual patient outcomes and overall
program performance.
The cohort review process has proven to be a very useful tool for
ensuring accountability, educating staff about protocols and goals,
and improving case management and prevention. 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. They are responsible for ensuring
that patients who are started on treatment finish treatment.
As a result, patients are less likely to “fall between the cracks”
and receive inadequate care. Since 1993, when the cohort reviews
began in New York City, the treatment completion rate there has
increased from less than 50% to 93%.
You may already conduct administrative reviews of TB cases and
contacts. The cohort review method builds upon many current
practices, but adds a quantitative difference to program review
and examination of treatment outcomes. It is a management
process that will motivate staff, reveal program 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.
Admittedly, 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.
To assist you in learning and applying the cohort review method,
a team from the Centers for Disease Control and Prevention and the
Charles P. Felton National Tuberculosis Center at Harlem Hospital
have developed the attached instruction guide. We believe
it provides an excellent starting point for program areas in implementing
the cohort review methodology.
I wish you success in adapting this methodology in your program
area. Improved program evaluation data will allow you to efficiently
apply your program resources and maintain TB control—the first steps
toward eliminating tuberculosis.
Sincerely,
Kenneth G. Castro, M.D.
Assistant Surgeon General
Director
Division of Tuberculosis Elimination
National Center for HIV, STD, and TB Prevention
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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