Initiating the Cohort Review Process in Los Angeles County Los Angeles County Tuberculosis Control...

Initiating the Initiating the Cohort Review Process Cohort Review Process

in Los Angeles County in Los Angeles County

April King-Todd, R.N., B.S.N, M.P.HNurse Manager

Los Angeles County Tuberculosis Control Program Los Angeles County Tuberculosis Control Program

Critical Stakeholders• Internal

– SPA Medical Staff (AHO, AMD, Chest MDs, etc.)– SPA Nursing Staff (Nurse Managers, PHNSs, PHNs,

Clinic staff and CWs, etc.)– SPA Administrative Staff (Assist. S.A., F.A, Clerical,

etc.)– TB Control Staff (APS, STC, PS)– CHS and Program Administration– Dr. Jonathan Fielding-Director, LAC DPH

• External: – CA State TB Branch– CDC– Patients

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Reasons for Implementation• 2010-2014 CDC Cooperative Agreement requirement

• Evidence-based methodology to improve case management

• Quality assurance tool to conduct program evaluation

• Improve documentation

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DescriptionCohort Review vs. TB Case Review

• Integrated (TBCP & CHS) team approach

• Retrospective review of All TB cases and their contacts initiated during a quarter

• Monitors group of patients’ progress toward treatment outcomes

• Identifies system (process), patient care and programmatic issues

• Outcome data

• PHN, PHNS, or MD

• Real time ongoing review of specific patient management

• Monitors individual patient progress and treatment

• Identifies patient clinical care issues as part of the case management process•

Los Angeles County (LAC) Cohort Review Model

“Face-to-Face”

• The LAC cohort review process is unique:– Inclusion of TB suspects pending

confirmation/closure – Planned use of electronic TRIMS auto-populated

case presentation/Contact Inv. forms

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LAC TB Cohort Review Team

Public Health Nurse Supervisor

Medical Reviewer

(Chest MD)

Case Manager(Public Health Nurse)

TB Controller or TBCP

MD

TBCP staff

CHS staff

Community Health Services Director

Team Manager(Area Med. Dir./

Nurse Mgr.)

SCN/Designee, SPHI/Designee,Community Worker

&Business Office Staff

Data Analyst(TBCP

Epidemiologist)

TBCPHealth Center APS,

NM, PS

TBCP Staff Role & Responsibilities (1)

Title

TBCP Physician

Cohort Review Presentation 1.Attend in person or via teleconference2.Ask questions of clarification, makes suggestions3.Review clinical practice based on current/updated policies, standardized practice

TB Health Center APS,

PHN

Co-Coordinator and instructor

Preparation 1. Provide technical assistance/guidance to CHS staff2. Provide preliminary Cohort Review line lists (open TB Suspects &

TB Cases) four weeks prior to cohort review session 3. Provide Final Cohort Review line lists to TB Chest MD, PHNS,

business office manager two weeks prior to review date 4. Coordinate cohort review preparation, presentation and follow-up

with the assigned CHS PHNS (coordinator/documentation of issues identified during cohort review session)

5. Assist and coordinate with TBCP NM and PS on ‘Cohort Review Process’ and ‘Case management’ trainings

Continued on next page

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Title

Cont’d

TB Health Center APS,

PHN

Co-Coordinator

and instructor

Cohort review presentation1. Attends and Asks questions of clarification

Follow-up after cohort review1. Tracks education, programmatic and clinical issues

needing follow up2. Ensure that ongoing, follow -up staff education

incorporates program strengths and weaknesses


Title

Epidemiologist/Data Analyst

Preparation: 1. Reviews the final Cohort Line List for the quarter2. Prepare spreadsheet for cohort data collection3. Provide SPA/Health Center NTIP performance data4. Prepares Cohort overall statistics (e.g. demographic information, site of disease, bacteriology, radiology, drugs, DOT, status of treatment completion, contact investigation results, etc.)

Cohort review Presentation 1. Presents preliminary Cohort overall statistics and the data summaries for the previous cohort quarter reviewed, if indicatedContinued on next page


Title

Epidemiologist/Data Analyst

2. Updates and analyzes cohort data and provides immediate feedback to SPAs on how they ‘re doing in relation to program objectives

3. Provides (3) Summary Reports• Variables• Indices/Rate for Treatment of TB Cases • Contact Investigation Data from Cohort Review

Follow up after the cohort review 1. Compiles summary report with CR outcomes and

provides the report to designated health center staff2. Provides a list of data issues that require follow-up

actions to designated health center staff


Title

TBCP Nurse Manager (NM) and Program Specialist, PHN

1. Develop LAC TB Cohort Review Instructional Guide with CR tools, for Cohort Review team.

2. Develop curriculum for ‘TB Cohort Review Process’ and ‘Case Management’ and provide training for entire Cohort Review team

3. Provide technical support to TBCP H.C. APSs and data analyst

4. Assist H.C. APSs in coordinating cohort review preparation, presentation, and follow-up with CHS staff

CHS Staff Role & Responsibilities (1)Title

Area Medical Director (AMD)-/Nurse Manager (NM)

Has the list of TB cases and calls them to be reviewed

May group the cases to allow some essential staff to leave before the end of the session.

Preparation:1. Ensures staff at all levels understand the cohort review process, has the knowledge and skills to perform this task and ensures the attendance of Health Center TB TeamCohort review presentation1. Facilitates the introduction of on-site participants and any call-in participants. 2. States the “Ground Rules” before Cohort Review begins.3. Listen to all case presentations4. Ask questions of clarification to ensure all aspects of case management adhere to the department of public health policies and procedures5. Use teachable moments to illustrate important lessons in effective TB control.Follow Up after cohort review presentations1. Ensure medical management and other issues are addressed2. Address programmatic concerns and concerns about modifying staff training or orientation to better meet the needs for staff to learn what they need to do the job3. Submits TB case summary to Director of CHS and TBCP evaluation coordinator.

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CHS Staff Role & Responsibilities (2)

Title

Chest MD/(Medical reviewer)

Preparation1. Ensures the attendance of Health Center TB Team2. Review the Cohort Review line list /medical records prior to cohort review presentation date.

Cohort review presentation1. Listens to all case presentations and review support documentation (e.g., medical records, TRIMS), and ask questions for clarification about each case, prompt for details of staff efforts: likelihood of completing treatment in 12 months (e.g., status of pursuit of patients lost)2. Provide feedback and suggestions on how to follow up patients and their contacts. Ensures all aspects of case management adhere to DPH policies and procedures are followed including but not limited to the following:Continued on next page

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Title

a. Drug regimen is appropriate per drug susceptibility results

b. Sputum conversion documented

c. Contact investigation outcomes are assessed

d. Adherence issues, home isolation issues addressed

3. Use teachable moments to illustrate important lessons in effective TB case management.

Follow Up after cohort review presentations 1. Address any medical management issues identified 2. Ensure ongoing staff education

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Title

Public Health Nurse Supervisor (PHNS)/Coordinator & Documents issues identified during cohort review session

Preparation: 1. Supervise and assist PHN staff in following case management protocols. 2. Hold one-on-one case review meetings with PHNs per LAC PHN practice manual. 3. Conduct periodic conference meetings with entire team if necessary. 4. Review the final Cohort Review line list 5. Ensure PHN case presentation will be concise and according to standardized format. 6. Review the case presentation /contact investigation forms that each DPHN have prepared to ensure that all information is complete 7. Coordinate cohort review preparation, presentation, and follow-up with the assigned H.C. APS


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Title

(Cont’d) 8. PHNS (assigned CHS coordinator) receives 6 copies of the forms on each case and sorts them by the order on the final cohort review lists. Each set of the copies will be provided to AMD, Chest MD, NM(s), PHNS, and TBCP Controller/MD, TBCP Epidemiologist on the day of the cohort review presentation.

Cohort review presentation 1. Attend with staff 2. Allow PHN to present 3. Determine any training issues, needs for PHN staff and

communicate this to TBC APS Follow up after cohort review 1. Ensure PHN follows up on case management suggestions

(making sure that patients and contacts finish their treatment), and complete any missing information and clarifies details and information as identified during the cohort review

2. Meet with PHNs and provide feedback for future presentations


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Title

Case Manager

(District Public Health Nurse)

Preparation: 1. Participates in case review meetings with PHNS and case conferences with clinic TB team. 2. Follow all protocols for PHN case management and contact investigation. 3. Communicates periodically with community workers and clinic staff for issues affecting patient adherence .4. Prints case presentation form from TRIMS for cases to be presented 5. Updates any missing info prior to cohort review presentation and provides updates at the meeting. 6. Prepares self for cohort review presentation(s) 7. At least 2 days prior to scheduled cohort review presentation date, makes 6 copies of the completed case presentation forms and gives them to his/her supervisor to provide them to assigned PHNS (coordinator).Continued on next page


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Title(Cont’d) Cohort Review Presentation

1. Delivers concise presentation using case presentation form, answer any questions from the team members, and ask questions related to patient care contact investigation issues to brainstorm with fellow collaborative team.

Follow up after the cohort review 1. Follow up on case management suggestions (making sure that patients and contacts finish their treatment .2. Obtain any missing information identified during the cohort review.3. Meet with supervisor for feedback to enhance preparation for the next cohort review, continue case management. Report to PHNS and/or TB Chest MD, updates case/contact information in TRIMS .


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Title

Supervising Clinic Nurse I or designee

Preparation 1. Participates in case conferences with clinic TB team 2. Communicates periodically with DPHN, and clinic staff for issues affecting patient adherence.

Cohort Review Presentation 1. Attend and provide additional information as requested2. Follow up on clinic issues

Community Workers (CWs)

Preparation 1. Participates in case conferences with clinic TB team 2. Communicates periodically with DPHN, and clinic staff for issues affecting patient adherence. Cohort review Presentation 1. Attend for assigned cases and provide additional information as needed


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Title

Supervising Public Health Investigators (SPHI) or designee

Preparation

1. Participates in case conferences with clinic TB team

Cohort review Presentation

1. Attend and provide additional information as needed

Business Office staff

Preparation

1. Pull patient charts from Cohort Review line list and delivers them to TB Chest MD a week prior to the review date

Core Elements for Cohort Review

Cohort Review Process

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Preparation Presentation Follow-Up

Preparation

• Comprehensive case management

• Reliable TB registry

• TB Indicators

• Collecting/entering info in TRIMS on cases

for presentation

• Standardized format

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Category Indicator 2015 National Objective

2004-08 National Average

2004-08 LAC Baseline

1Completion of Treatment

Percent of patients with newly diagnosed TB for whom 12 months or less of treatment is indicated, who complete treatment within 12 months.

93.0% 71.7% 76.5%

3 Contact Investigation Aggregate Reports for Tuberculosis Program Evaluation – Contact Investigations

Contact ElicitationPercent of newly diagnosed TB patients with positive acid-fast bacillus (AFB) sputum-smear results who have contacts elicited.

100.0% 92.2%* 92.2%

Contact EvaluationPercent of contacts to sputum AFB smear-positive TB patients who are evaluated for infection and disease.

93.0% 80.4%* 99.5%

Treatment InitiationPercent of contacts to sputum AFB smear-positive TB patients with newly diagnosed latent TB infection (LTBI) who start treatment.

88.0% 70.5%* 55.8%

Treatment Completion

Percent of contacts to sputum AFB smear-positive TB patients who have started treatment for the newly diagnosed LTBI, who complete treatment.

79.0% 63.3%* 51.1%

Selected TB Indicators and Performance Targets

Sample Preliminary Cohort List for TB Cases (______Quarter)

DP # Ln Fn D_Birth Chart Supt HIVDOT

Prim Disease Cavitary

Smear Cult.

D_Initiate

d

D_Confirm

ed Rx_Star

t Rx_ Comp

Closure

RsnCensus Tract

7XXXXX L X/XX/XXXX XXXX PMD 1 1 Y PO POX/XX/XXXX

X/XX/XXXX

X/XX/XXXX

XX/X/XXXX

comp. tx 2393.1

7XXXXX S X/XX/XXXX XXXX Public 1 1 Y NE POX/XX/XXXX

XX/X/XXXX

X/X/XXXX

XX/XX/XXXX

comp. tx 5402.02

7XXXXX J X/XX/XXXX XXXX Public 1 1 Y PO POX/X/XXXX

X/XX/XXXX

X/X/XXXX 2374

7XXXXX G X/XX/XXXX XXXX PMD 0 1 PO POX/XX/XXXX

X/XX/XXXX

X/XX/XXXX died 2402

Sample Final Cohort List for TB Cases (______Quarter)

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Fn D_Birth Chart Supt HIV DOT Prim Disease Cavitary Smear Culture D_Initiated D_Confirmed Rx_Start Rx_ Comp Closure Rsn PHN

A. ######### xxxxxxx PH NE No Pul N neg neg 1/20/2010 Not TB Ma M

N. 5/18/19XX xxxxxxx PMD PO No Pul N neg neg 2/10/2010 Moved Na R

K. 2/10/19XX xxxxxxx PH NE No Pul/LN N neg neg 2/10/2010 Stil l open Ka C

LAC Case Presentation

Form

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Los Angeles County Department of Public Health COHORT REVIEW CASE PRESENTATION FORM

DP #: Medical Record #: PHN: Patient Name: Date of Birth: Gender:

Race:[If Asian Shows Country] Ethnicity: [Hispanic or Non-Hispanic] Country of Origin: [Country of Birth] Date Arrived in U.S.: [Date of Arrival or Date of Birth if US Born] Primary Occupation Within the Past Year: [Shows Answer]

Health Care Worker; Correctional Facility Employee; Migrant Seasonal Worker; Other Occupation; Retired; Unemployed; Not Seeking Employment

Resident of Correctional Facility at Time of Diagnosis: [Federal Prison; State Prison; Local Jail; Juvenile Correction Facility; If Other Correctional Facility:, ?Under Custody of Immigration & Customs Enforcement? Resident of Long-Term Care Facility at Time of Diagnosis: [Nursing Home; Residential Facility; Alcohol or Drug Treatment Facility; Hospital-Based Facility; Mental Health Residential Facility; Other Long Term Care Facility] RISK FACTORS [Will list only those Risk Factors which were answered ‘Yes’] Homeless Injecting Drug Use Within Past Year Non-Injecting Drug Use Within Past Year Excess Alcohol Use within Past Year HIV status [Shows answer] Date HIV test [Will show answer if done] If HIV status ‘Positive’, HIV drugs _____________________________________________________________________________ , HIV Provider ______________________________(not available in TRIMS) Additional TB Risk Factors: [Will list only those Risk Factors which were answered ‘Yes’] Contact of MDR-TB Patient Post Organ Transplantation Contact of Infectious TB Patient Diabetes Mellitus Missed Contact End-Stage Renal Disease Incomplete LTBI Therapy Immunosuppression (Not HIV/AIDS) TNF-α Antagonist Therapy Other: Specify Current smoker DIAGNOSTICS Primary Reason Evaluated for TB: [TB Symptoms; Abnormal Chest Radiograph; Contact Investigation; Targeted Testing; Health Care Worker; Employment/Administrative Testing; Immigration Medical Exam (B-Notification); or Incidental Lab Result] Patient Status at Diagnosis: [Alive or Dead] Patient is diagnosed with: [Pulmonary TB; Both Pulmonary & Extra-Pulmonary TB; Extra-Pulmonary TB] Primary Site of Disease: [List All in Field] Confirmation is based on: [Use VerCrit Field: Positive Culture; Positive NAA; Positive Smear/Tissue; Clinical Case Definition; or Verified by Physician Diagnosis] IGRA Test Results: [Positive; Negative; Indeterminate] result from [IGRA Type – QFT G iT] specimen collected on [Date Collected] Mantoux Tuberculin Skin Test Results: [mm] mm, read on [Date Read] Chest X-Ray Result: [Normal; Abnormal (Cavitary); Abnormal (Non-Cavitary); Abnormal Not TB] Sputum Smear Results: [Positive or Negative] Sputum Culture Results: [Positive or Negative] Other Source [Specimen Type] Smear Results: [Positive or Negative] Other Source [Specimen Type] Culture Results: [Positive or Negative]

Contact Evaluation Summary

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Los Angeles County Department of Public Health COHORT REVIEW CONTACT INVESTIGATION FORM

DP #: Medical Record #: PHN: Patient Name: Date of Birth: Gender: _________

Part I: Contact Evaluation Sputum Results: Smear: Culture: Other Pulmonary (clinical improvement/clinical evidence) : Genotyping [Show result] [This section not available in TRIMS] History of Cough: Yes or No (Circle One) Onset Date:___________________ Infectious Period: Begin Date:_________________ End Date:__________________ Were Contacts Identified: Yes (generate information below); No (no info to generate below)

Part I: CONTACT ELICITATION-EVALUATION

NUMBER Reference

Number of Contacts Elicited a Number of Contacts Evaluated b Number of Contacts with TB Disease

c

Number of Contacts with Latent TB Infection

d

Number of Contacts Initiating Treatment

e

Number of Contacts Completing Treatment

f

Reasons LTBI Treatment Not Completed

Contacts Died

Prior to Cohort Review Presentation• The PHN Supervisor reviews the forms that each

DPHN has prepared to ensure that all of the information provided is complete

• 2 days prior to scheduled cohort review presentation date, DPHN makes 6 copies of the completed forms on each case

• DPHN gives 5 copies to assigned PHNS coordinator who sorts them by the order on the final cohort review list

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Presentation

• TBCP Epidemiologist presents preliminary summaries for the cohort being reviewed during the session, and the data summaries for the previous cohort quarter reviewed, if indicated.

• Detailed Review of Each Case

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Presentation• The AMD/NM chairs the cohort review meeting.

• The PHN presents the patient case data and contact information using a standardized form to the Cohort Review team.

• The AMD and/or chest MD asks questions for clarification, prompts for details of staff efforts to solve problems (e.g. trace patients who are lost), and provides feedback and suggestions on how to follow up on the cases and their contacts.

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Presentation• Clinical staff involved in managing the cases can provide

additional information as needed. • As each PHN describes the case details, the TBCP epidemiologist tallies the data elements

needed to evaluate the objectives.

• PHNS(designated documentation coordinator) will document issues, feedback, suggestions on how to follow up on the patients and their contacts in a standardized manner.

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LAC Cohort Review Meeting Agenda

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December 14, 2010

Review of TB suspects/cases initiated between Jan.- March 2010 and their contacts

AGENDA

TIME TOPIC Who 1:00 PM – 1:15 PM

Introductions, Review Ground rules, Confidentiality Statement

Facilitator

1:15 PM – 1:30 PM

Preliminary report on current cohort TBCP Epidemiologist,

1:30 PM – 2:30 PM

Presentation of Ist Quarter cases by PHNs - Open TB Suspects - Confirmed TB Cases

Questions, clarification, identification of issues from chest MD, AMD on each case

Decisions about disposition of each case

Facilitator Case Managers Medical Reviewer

2:30 PM – 2:45 PM

Break

2:45 PM – 3:30 PM

(Continued) Presentation of Ist Quarter cases by

PHNs - Confirmed TB Cases

Questions, clarification, identification of issues from chest MD, AMD on each case

Decisions about disposition of each case

Facilitator Case Managers Medical Reviewer

3:30 PM – 3:50 PM

Updated report on current cohort Action items and follow-up issues for

next cohort review session

TBCP Epidemiologist Documentation coordinator

3:50 PM – 4:00 PM

Wrap up Determine next Cohort Review

session date

Facilitator

Next cohort review session: Feb.____, 2011 (Review of all suspects/cases initiated (reported) between April - June, 2010 and their contacts)

LAC Cohort Review Meeting Participant Ground Rules

• Begin and end on time

• Remain quiet during the case presentation

• Turn cell phones on vibrate -if you need to answer please go out of the room

• Listen to and Respect Others

• Provide positive and constructive feedback

• Right to disagree but not offensively

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• Measurable improvement on LAC TB performance through countywide implementation of the cohort process

Treatment Outcomes LAC 2009

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COT by Provider Type LAC 2009

39

40

2010 1st quarter Cohort

Summary of Cohort

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TALLY SHEET

Date Quarter Cases Counted January 1 to March 31, 2010

TB Information DOT DISPOSITION CONTACT

CommentsLn Dp_No Sm+ Cult+ Pulm CavCXR

Dot_'

a b c d e f g hi

j k #ID App Test #Eval #Inf #Tx LTBI #Comp #Curr

BA

BE

BR

CA

CL

DE

GA

HE

HO

JA

LE

LI

LO

OX

RI

SA

SP

ZA

TOTAL

DISPOSITION CONTACTS

a Patient completing recommended therapy #ID # of contact identified

b Likely to complete treatment within 365 days App test # of contacts appropriate for testing

c Noncount #Eval # contacts evacuatedd Reported at death #Inf # contacts infected

e Counted by "other" #trtLTBI # contact start on Tx for LTBI

f MDR and still on treatment #Comp # contact compl tx LTBI

g RIF resistant/intolerant and still on treatment #Curr # Contacts who are still on Tx LTBI

h Died during treatment

i Moved j Cohort failure k Lost

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Follow Up Essential on any Issues Identified:

•Treatment•Data•Contact Investigation•Case Management•Education & Training•NTIP Issues•Clinical•Medical Records

Follow-Up

Each participant has follow-up tasks to perform.

• PHN Supervisors & PHN case managers • Follow up on case management suggestions made during

the cohort review • Ensure that patients and contacts still on treatment finish

treatment. The outcomes of persons with TB disease who were “likely to complete” treatment and the contacts who are still on treatment for LTBI will be reported and reviewed in 6 months, as part of a future cohort review.

• Keep managing the cases and contact investigations until they are “closed”.

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Follow-Up• The AMD and/or NM will address programmatic

concerns and consider modifying staff training to address staff learning needs.

• The medical reviewer (Chest MD) will address clinical and programmatic problems that were noted and provide medical consultation.

• TBCP APS, PS, NM will track education, programmatic and clinical issues needing follow up and ensure ongoing, follow -up staff education

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SAMPLE COHORT REPORT CARD Quarter: 1/1/10 to 3/31/10

COMPLETION OF TREATMENT SPA: ________ SUMMARY OF VARIABLES TB Cases Counted 1/1/10-3/31/10 Count Total case counted 43

a Complete treatment 26b Likely to complete treatment 8c Noncount 1d Reported at death 2e Counted by "other" 0f MDR TB 1g RIF resistant/intolerant and still on treatment 0h Died during treatment 2i Moved 0j Cohort failure 1k Lost 1

TB Cases Counted 1/1/10-3/31/10 RateIndex of treatment completion at time of cohort review 65.0%Index of possible treatment completion 70.3%Index of likely to complete treatment 91.9%Death rate 9.5%Default rate 2.4%Total cohort failure rate 4.8%

REPORT CARD

COMPLETION OF TREATMENT

Reduced TB incidence

Reduced TB morbidity and mortality

Improved quality of patient life

Reduced TB transmission

Reduced LTBI prevalence

Activities OutcomesInputs/ Resources

Capacity & infrastructure

§ Adequate funding § Strong and well-staffed

programs§ Functional data systems,

including case management data system

§ Adequate physical, diagnostic and treatment resources

§ Policies, procedures and guidelines

§ Clinical, epidemiological, and operational research

Provide TB education and training to

community providers

Investigate Contacts§ Identify contacts quickly § Locate and evaluate in a timely manner

Find and treat active TB§ Identify early§ Use effective drugs§ Reduce treatment barriers

Monitor & evaluate§ Data driven interventions to

improve program activities defined & disseminated

Prevent TB in high-risk populations

§ Engage community partners§ Detect LTBI & TB

Coordinate and communicate effectively with providers outside HD

Provide patient education and treatment

Ensure:§ Patient on

appropriate treatment

§ Patient adheres to treatment

§ Timely completion of appropriate treatment

Enhancedaccountability

GoalElimination of

TB in LAC

2-1, 2-2

7-1

7-2,7-3

B,C,D,E

A

COHORT REVIEW

OS 9OS 9: Evaluate and improve programs and interventions

1

11

3 2

7,9

8

13

6

4,5,10,12

14,15

LAC Performance Measures

CDC National TB Indicators COHORT REVIEW

Integration of National TB Indicators and Los Angeles County Performance Measures

Staffing/Training required• 2011-Cohort review training

– All AMDs, NMs, PHNS, PHNs, PHIs & CWs 2 days training (divided over three sessions)

• RTMCC assistance with CEU

Cohort review process concept and roles (1 day) Cohort preparation/planning (½ day) onsite at health center Mock cohort review (½ day) onsite at one health center in

each mega spa

• 2012 Cohort Review sessions – Continue Cohort review training– All Health centers begin Cohort Review sessions

Cohort Review Implementation by December 2011

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SPA Jan. Feb. March April May June July August September October November December 1 & 2 Pacoima

3 & 4 Hollywood -Wilshire

5 & 6 Simms M South

7 & 8 Whittier

1 center in each Mega-SPA, selected based on CHS needs, and resources; but driven by epi.

Patients are seen at Hollywood-Wilshire H.C.

DPHNs are located at North Hollywood H.C.

LAC Program Evaluation Process(Cohort Review)

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Activities OutcomesInputs/ Resources

= Data and programs undergo continuous improvement

with ongoing monitoring and evaluation feedback

Monitor progress toward

objectives

Met target

Implement Improvements(CHS )

Did not meet target

Identify and share “Best Practices”

Provide justifications, develop action plan to

evaluate(CHS & TBCP Evaluation

Team)

Complete evaluation(CHS & TBCP Evaluation

Team)

Refine/develop activities based on findings

(CHS & TBCP Evaluation Team)

“Understanding the TB Cohort Review Process: Instruction Guide 2006” http://www.cdc.gov/tb/pubs/cohort/default.htm

National Tuberculosis Indicators Project (NTIP)http://www.cdc.gov/tb/pubs/tbfactsheets/NTIP.htm

Fujiwara PI and Frieden TR. TB Control in New York City; A Recent History. Atlanta, GA: CDC, Division of Tuberculosis Elimination. TB Notes 2000(1): 9-12.

MacMaken M. The Cohort Review Process in New York City. Atlanta, GA: CDC, Divisions of Tuberculosis Elimination. TB Notes 1997 (1).

Francis J. Curry National Tuberculosis Center; Quality Improvement for TB Case Management: An Online Course for Systematic Quality Improvement Program for TB Case Management. (2002).

References

http://www.cdc.gov/tb/pubs/cohort/default.htm

http://www.cdc.gov/tb/pubs/tbfactsheets/NTIP.htm

Acknowledgements:Acknowledgements:Karen Y. Cho, RN

Terese Brookins, EPISharelle Carr, RN

Frank Alvarez, MDJan King, MD AHO- SPA 6

South Health Center (SPA 6) staff

Thank You!Thank You!QuestionsQuestions

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