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 April 2009
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WA State
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WA State TB MorbidityA Medium Incidence State

• Population of over 6 million approx. 80,000
  births annually
• 2004 TB Data 244 TB cases (3.9/100,000) vs.
  (4.9/100,000) incidence in the U.S.
• Highest incidence in King County 133 cases
  (7.4/100,000)
• Comprised 55 of total TB cases in 2004

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WA State Profile TB Funding

• 39 counties comprise 34 Local Health
  Jurisdictions (LHJs)
• 74 local TB staff including managers, PHNs,
  administrative, outreach workers
• 890,000 of 1.4 million federal funds to 4 LHJs
• 5.6 million available in local funds for LHJs

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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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Impact of Cohort Review in WA StatePre (2001)
and Post (2004) ImplementationCase Summary
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Pre (2001) and Post (2004) ImplementationContact
Summary
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Post ImplementationCase Summary
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Post ImplementationCase Summary Timeliness
Measures(Washington Modification to NYC Model)
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Post ImplementationContact Summary
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Washington State Cohort Review 2007 Fourth
Quarter
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Percentage of cases on directly observed therapy
(DOT), North/South regions
91
80
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Percentage of cases offered an HIV test at time
of TB screening, North/South regions
92
90
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Percentage of infectious cases (smear ) likely
to complete medications, North/South regions

90
89
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Percentage of infectious cases lost to follow-up
or refused to continue treatment after starting,
North/South regions


0
0
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Median number of days between sputum collection
and receipt at a lab, North/South regions


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Median number of days between the smear date
and LHJ report of case to DOH, North/South
regions


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Cases October - December 2007 North/South
regions

• 80 of cases completed treatment 89 expected to
  complete
• 11 moved or died
• 3 lost
• 91 were on DOT (100 for smear)
• 8 not offered an HIV test
• 17 had medical adherence issues
• 9 had personal adherence issues
• 6 provider interrupted therapy

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Cases Oct - Dec 2007 North/South regions,
contd Median Number of Days Timeliness
Measures

• 3 cases had an MTD test
• Of those that didnt (n4 smear-culture cases)
• Median of 10 days between date sputum was
  collected and date they started meds
• Lab Sputum Collection 1 day
• Culture Testing 17.5 days
• Susceptibility 21 days

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Contacts October December 2007 North/South
regions

• 139 contacts identified to 36 cases 8 per case,
  median of 5.5
• 80 of smear cases identified contacts (2 case
  didnt)
• 10 smear cases identified 86 contacts
• 82 tested
• 57 evaluated for TB
• 21 infected
• 21 infection rate (diseased infected)
• 17 were infected by didnt start treatment
• 83 of infected started treatment and of those
• 20 completed (4 contacts)
• 55 currently on or not closed out in our
  database
• 20 Provider discontinued meds (contacts to
  pediatric cases) (4 contacts)
• 5 Moved (1 contact)

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Contacts and References

• Kim.Field_at_doh.wa.gov 360-236-3447
• http//www.doh.wa.gov/cfh/TB/Manual/Forms/CohortPr
  esentation.pdf
• http//www.doh.wa.gov/cfh/TB/Manual/Forms/CohortDi
  ctionary.pdf

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References

• S\CFH\IDRH\TB Services\Cohort Review\Generic
  Forms