The Cohort Review Process in Washington State

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The Cohort Review Process in Washington State
Kim Field, RN, MSN Washington State Department of
Health kim.field_at_doh.wa.gov Website
www.doh.wa.gov/cfh/tb September 16, 2005
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Topics To Be Discussed

• 2-Part Presentation
• WA State Profile
• Impact of cohort review
• Implementation of cohort review process in WA
  State
• WA State TB objectives

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Reasons for Implementation

• 2005 CDC Cooperative Agreement
• Increase learning
• Improve case management at the state and local
  levels
• Use cohort review as a tool to conduct program
  evaluation
• Improve documentation in clinic records

4
Gaining Support of Staff

• Received info from NYC
• Gained support of state TB epidemiologist who
  reviewed NYC cohort review materials
• Need to convince staff of benefits
• Many meetings!
• Refinements continuing

5
Cohort Review Process in WA

• Nursing Consultants continually work with local
  health jurisdictions (LHJs) to review cases and
  prepare for cohort review sessions
• LHJ staff or Nursing Consultants present cases
• During session, TB Program Manager and MDs ask
  questions and provide education

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Cohort Review Process in WA, Cont.

• At beginning of session, epidemiologist presents
• Final analyses of previous cohort of cases and
  contacts
• Preliminary analyses of cases being reviewed

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Cohort Review Process in WA, Cont.

• Analysis of TIMS and WA State Contacts Database
  using SAS software program
• Epidemiologist uses cohort review forms for
  timeliness measures
• A program to automatically analyze timeliness
  measures has been created

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Cohort Review Timeline
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Modifications to NYC Model

• Revised cohort review form
• Added assessment of HIV screening not offered
• Added evaluation of adherence to treatment for
  cases and contacts
• Data summaries generated from TIMS, Contacts
  Database, and cohort review forms

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Modifications, Cont.Timeliness Measures for Cases

• Average number of days
• Sputum collected to received at lab
• Sputum smear and cavitary CXR to TB meds
  starting
• For cases with and without MTD testing, sputum
  collection to TB meds starting

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Modifications, Cont.Timeliness Measures for
Cases

• Average number of days
• Sputum smear to case reporting from private
  provider to LHJ
• Sputum smear to reporting from lab to LHJ
• Sputum smear to case reporting from LHJ to DOH
• MTB culture to reporting drug susceptibility
  from lab to LHJ

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Modifications, Cont.Timeliness Measures for
Contacts

• Average number of days
• Sputum smear and cavitary CXR to date contacts
  identified

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2005 2009 WA State TB Objectives

• By 2009
• Surveillance
• All diagnosed cases of TB will be reported to
  CDC. There will be 95 percent completeness for
  key variables in the RVCT
• 60 of immigrants and refugees designated as
  Class B1, B2 will be appropriately evaluated
  within 60 days

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2005 2009 State TB Objectives, Cont.

• Treatment and Case Management
• 95 of TB patients will complete a course of
  treatment within 12 months
• 85 of TB patients will be on DOT
• HIV status will be reported for 90 of all cases
• Drug susceptibility will be reported for 95 of
  all culture-positive TB cases
• Decrease the TB incidence rate to 4.0
  cases/100,000 among American Indian/Native
  Alaskan persons

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2005 2009 State TB Objectives, Cont.

• Contact Investigation
• Contacts will be identified for 90 of sputum
  smear positive TB cases
• 75 of contacts to sputum smear positive TB cases
  will be evaluated
• 70 of infected contacts will start on treatment
  and complete
• Human Resources
• The American Lung Association of WA will
  implement and maintain TB training and human
  resource development

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2005-2009 State TB ObjectivesA National
Measurement of Our Success as a State

• 1999-2003
• 90 of TB patients completed a course of TB
  treatment within 12 months of initiation
• 75 of patients were on DOT

• State Objectives, by 2009
• 95 of TB patients will complete a course of TB
  treatment within 12 months of initiation
• 85 of patients being treated for active TB will
  be on DOT

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2005-2009 TB Objectives, Cont.A National
Measurement of Our Success as a State

• 1999-2003
• HIV status was reported for 89 of all reported
  cases
• Drug susceptibility results were reported for 99
  of all culture-positive TB cases

• State Objectives, by 2009
• HIV status will be reported for 90 of all newly
  reported TB cases
• Drug susceptibility results will be reported for
  95 of all culture-positive TB cases

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2005-2009 TB Objectives, Cont.A National
Measurement of Our Success as a State

• State Objectives, by 2009
• Contacts will be identified for at least 90 of
  sputum smear cases
• 75 of contacts to sputum smear cases will be
  evaluated
• 70 of infected contacts started on treatment
  will complete

• 1999-2003
• Contacts were identified for 82 of sputum smear
  cases
• 57 of contacts to sputum smear cases were
  evaluated
• 47 of infected contacts started on treatment,
  completed (reporting delay)

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QUESTIONS ????

• CONTACTS
• Alexia Exarchos, Epidemiologist
• 360-236-3413 alexia.exarchos_at_doh.wa.gov