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Understanding the TB Cohort Review Process: Instruction Guide
2006
Return Table of Contents
What Is the Cohort Review Method?
2. Roles of the TB Control
Team
Tuberculosis control teams throughout the United States are composed
of health professionals with many different job titles and roles.
Urban, high-incidence areas may have a unit large enough to be divided
into specific functional teams. In contrast, rural or low-incidence
areas may have only a few staff who manage the entire TB program.
For the purpose of outlining the cohort review approach, we will
highlight five functional roles for TB control team members:
TB program manager, medical reviewer, data analyst, supervisor,
and case manager. It is important to note that although the
roles have been given “position titles,” these may be different
in some settings. Depending on the size and make-up of the
TB control team, members might also play multiple cohort review
roles. In reading this section, one should focus on the functions
for each of the team members rather than the specific position title.
The sample organizational chart below reflects the possible interrelationship
of team members.
At first glance, a cohort review presentation may seem to be only
a presentation of outcomes of TB case management activities.
In reality, the cohort review presentation is the culmination of
a long process that begins the day the case is reported, far in
advance of the presentation day. The following tables highlight
the specific roles of members of the TB control team in preparing
for and conducting a cohort review. These roles will be explored
in more detail as each element of the cohort review process is explained.
Table 3: Role of the TB Program Manager
TB Program
Manager |
Preparation for a cohort review
- Demonstrate commitment to the cohort review process.
- Ensure staff at all levels understand the reasons for
undertaking cohort reviews.
- Ensure staff at all levels have the knowledge and skills
needed to perform the tasks required.
Cohort review presentation
- Listen to all case presentations.
- Ask questions of clarification to ensure that all aspects
of case management adhere to department of health policies
and procedures.
- Use teachable moments to illustrate important lessons
in effective TB control.
Follow-up after cohort review
- Ensure that medical management and other issues are
addressed.
- Ensure that ongoing, follow-up staff education incorporates
program strengths and weaknesses.
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Table 4: Role of the Medical Reviewer
Medical Reviewer |
Preparation for a cohort review
- Demonstrate commitment to the cohort review process.
- Ensure staff at all levels understand the reasons for
undertaking cohort reviews.
Cohort review presentation
- Listen carefully to all case presentations and review
available support documents (e.g., printouts from TB registry,
charts, and medical records).
- Ensure that all aspects of case management adhere to
department of health policies and procedures. This
includes ensuring that
– Activities are completed in a timely manner
– Data are complete (e.g., date of birth, entry to US,
HIV status)
– Drug regimen is appropriate (e.g., probe for explanations
for nonstandard regimens)
– Susceptibility results are obtained, drug regimen adjusted
if necessary
– Sputum conversion and completion of treatment are documented
– Contact investigation activities and outcomes are assessed
- Ask questions of clarification to make sure policies
and procedures were followed and the outcome is satisfactory.
- Use teachable moments to illustrate important lessons
in effective TB control.
Follow-up after cohort review
- Ensure that medical management issues are addressed.
- Ensure that ongoing, follow-up staff education incorporates
program strengths and weaknesses.
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Table 5: Role of the Data Analyst
Data Analyst |
Preparation for a cohort review
- Prepare lists of cases to be reviewed ahead of time:
preliminary cohort list 5 months before cohort review,
final cohort list 2 months before cohort review.
- Distribute the lists to case managers and supervisors
so they can be prepared to present these cases.
- Enter relevant information on each case and contact
on the cohort summary sheet.
- Prepare a summary of the current cohort to present
at the review session.
- Calculate the outcomes of previous cohort patients
who were likely to complete and contacts who were still
on treatment for LTBI.
Cohort review presentation
- Present summary of the current cohort of cases.
- Record data on treatment outcomes and other missing
information, while the case managers present each case.
Note any issues for clarification.
- Tabulate or calculate the treatment outcomes for cases
and contacts; present this at the end of the cohort review
session.
Follow-up after cohort review
- Write a report of the cohort review outcomes and distribute
it to everyone who has a need to know.
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Table 6: Role of the Case Manager
Case Manager |
Preparation for a cohort review
- Follow all protocols for case management to
ensure that patients adhere to treatment, comply with
medical visits, and complete treatment.
- Follow all protocols for contact investigation
to ensure that contacts are identified and evaluated,
and that they complete treatment for LTBI, if appropriate.
- Communicate periodically with clinic and outreach workers
to ensure everything is proceeding without problems; troubleshoot
problems.
- Participate in case review meetings with your supervisor
and case conference meetings with your TB control team
as these are scheduled.
- Ensure a complete job had been done (e.g., all loose
ends are tied up, all details are considered, and you
have information to answer any questions).
- Prepare a concise presentation of the case according
to a standard format.
- Participate in a mock cohort review session to practice
your presentation and become accustomed to handling questions
that might arise (optional).
Cohort review presentation
- When the TB program manager calls one of your cases,
speak loudly and clearly as you deliver your concise presentation.
- Answer questions from the TB program manager, medical
reviewer, data analyst, or other TB team members.
- Ask any questions you may have about patient care issues.
- Ask your fellow caseworkers and supervisor to provide
any information relevant to your case presentation if
necessary.
- Follow-up after cohort review
- Follow up to obtain any missing information or clarify
details that were noted during the cohort review.
- Update TB registry information as needed.
- Meet with your supervisor to discuss what went well
and what could be improved for the next cohort review
in 3 months.
- Continue case management if patient has not completed
treatment; continue contact investigation activities until
contacts who should start or complete LTBI treatment have
done so.
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Table 7: Role of the Supervisor
Supervisor |
Preparation for a cohort review
- Supervise and assist your case management and
contact investigation staff in following protocols.
- Hold one-on-one case review meetings with each staff
member.
- Hold periodic case conference meetings with your entire
team.
- Troubleshoot problems with staff.
- Make sure staff prepare a concise presentation of the
case according to a standard format.
- Hold a mock cohort review session for staff to practice
presentation skills. Ask them the kinds of questions
that might arise in a real cohort review.
- Cohort review presentation
- Let staff members speak for themselves.
- Only add something if more detail or confirmation of
the approach or activities is required.
Follow-up after cohort review
- Follow up to ensure staff obtain missing information,
clarify details, and update TB registry information, as
noted during the cohort review.
- Meet with staff as soon as possible to discuss what went
well and what could be improved for the next cohort review
in 3 months.
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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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