Journey of a New TB PEN Focal Point

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Evaluation of Sputum Culture Conversion

• Journey of a New TB PEN Focal Point
• Debbie Staley, RN, BSN, MPH
• Virginia Department of Health
• Division of Disease Prevention
• TB Control Program
• TB PEN Conference, September 21, 2011

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Sputum Conversion Evaluation Plan Development

• Topic of evaluation determined in the
• Program Evaluation Framework, 2010 for
  Virginia Department of Health, Division of
  Disease Prevention, TB Control and Prevention
  Program
• Assessed two indicators in 2010
• Sputa collection if respiratory site of disease
• Documented sputum conversion if sputa culture
  positive

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Rationale for Evaluation Focus

• Sputum culture conversion with weakest
  performance in 2008, at 42.2
• Evaluation of sputum culture conversion is
  dependent on sputum collection for those with
  respiratory site of disease.

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Evaluation Objectives

• Improve the percentage of patients who culture
  convert within 60 days of treatment initiation
• Describe the differences between those who
  convert and those who did not convert
• Determine if results are available but not
  reported or if specimens were not collected
• Develop strategies for improvement in areas where
  impact is possible

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Journey of a New TB PEN Focal Point

• September 2010- TB Focal Point responsibilities
  began
• Cohort Review conducted at central program level
  for 2009
• Attended cohort review webinar and on-site
  training, November 2010
• Informed of the need to conduct a focused
  evaluation of sputum collection and conversion

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Evaluation of 6 Indices for all 2009 TB Cases

• Completed internal central office cohort review
• Collated data using Excel spreadsheet
• 271 TB cases reported in 2009
• 225 with respiratory site of disease
• 92.9 with sputa collected
• 140 sputa culture positive
• Sputum culture conversion 59.1

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Virginia Department of Health

• 35 Health Districts
• 2 Districts not organizationally part of VDH
• 1 Of these Districts with 31.7 of 2009 Virginia
  morbidity AND use their own lab
• This district the focus of sputa conversion
  investigation

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Evaluation Activities

• Phone calls and faxes to district of major
  morbidity
• Sputum conversion outcomes
• Sputa was collected in all but two cases, of 8
• Sputa not collected (1)
• Client unable to produce sputa with induction (1)

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Outcomes

• Failure to convert due to
• Extensive disease
• Inadequate serum drug levels
• Drug resistance
• Failure to collect sputa in a timely manner
• Patient unable to cough with induction
• Staff turnover/vacancies
• Improvement in sputum conversion from to
  59.1 with only intervention education re
  upcoming cohort review plans

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The Ah-ha Moment Cohort vs. RVCT

• Cohort definition
• The proportion of TB patients with positive
  sputum culture results who have documented
  conversion to sputum culture negative within 60
  days of treatment initiation.
• Data Sources RVCT fields sputum culture, date
  therapy started, date therapy stopped, reason
  therapy stopped, sputum culture conversion
  documented and
• Calculation number of TB patients with positive
  sputum culture results who have documented
  conversion to sputum culture-negative within 60
  days of treatment initiation.

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RVCT Definition

• RVCT definition (a.k.a. NTIP definition)
• Complete only for patients who had 1 or more
  positive sputum cultures and who subsequently had
  at least 1 documented negative culture. This
  date should be at least 1 week after the last
  positive culture result. There should be no
  positive cultures after this date.

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Discussion? Questions?