Evaluating tuberculosis surveillance and action in an urban and rural setting
This presentation is the property of its rightful owner.
Sponsored Links
1 / 16

Evaluating Tuberculosis Surveillance and Action in an Urban and Rural Setting PowerPoint PPT Presentation


  • 46 Views
  • Uploaded on
  • Presentation posted in: General

Evaluating Tuberculosis Surveillance and Action in an Urban and Rural Setting. Kristine Lykens, Ph.D. In collaboration with Anita Kurian, MPH, MBBS Patrick Moonan, MPH Stephen E. Weis, D.O Date: June 27, 2005. Project. A collaborative effort between

Download Presentation

Evaluating Tuberculosis Surveillance and Action in an Urban and Rural Setting

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Evaluating tuberculosis surveillance and action in an urban and rural setting

Evaluating Tuberculosis Surveillance and Action in an Urban and Rural Setting

Kristine Lykens, Ph.D.

In collaboration with

Anita Kurian, MPH, MBBS

Patrick Moonan, MPH

Stephen E. Weis, D.O

Date: June 27, 2005


Project

Project

A collaborative effort between

  • Center for Disease Control and Prevention,

    Division of Tuberculosis Elimination

  • University of North Texas Health Science Center -

    Fort worth

  • Texas Department of Health

  • American Lung Association

  • Florida Department of Health


Evaluating tuberculosis surveillance and action in an urban and rural setting

Performance Analysis Methods

Draft of Performance Indicators

TB 400 A, TB 400 B

Stakeholder Focus Groups

TB 340, TB 341

CDC

Matrix of 34 indicators finalized

Initial set of 144 indicators selected

Program Staff

State database (TIMS, State lab)

M/E Practices

Evaluation Staff

Local database (HIV database, PNS screenings)

State Department of Health

Selected program Staff Interviews

County Health Department


Evaluating tuberculosis surveillance and action in an urban and rural setting

FOCUS GROUP

I

FOCUS GROUP

II

FOCUS GROUP

III

FOCUS GROUP

IV

Number of Participants

12

8

6

12

Professional Level

Medical Directors

Project managers

Clinicians

Mid-level supervisors

Clinic/

Outreach Nurses

Contact investigators

Outreach workers

Clerks

Medical records staff

Nurses

(TDH 2/3)

Contact Investigators

(TDH 2/3)


Evaluating tuberculosis surveillance and action in an urban and rural setting

Training

Supervision

Communications

Resource provision

Feedback

Support Activity

Acute (Epidemic-Type) Response

Analysis

Confirmation

Public Health Surveillance

Public Health Action

Reporting

Planned (Management-Type) Response

Registration

Data-Information-Messages

Detection

Conceptual Framework to Evaluate TB Surveillance and Action1


Data sources

Data Sources

  • Registered Public Health Records – TB 400 A, TB 400 B, TB 340, TB 341.

  • Selected staff interviews – Medical Director, Program Manager, Outreach supervisor, Medical records clerk, Billing clerk.

  • Local and State level databases

    • Local database – HIV database maintained by Medical records clerk, and the PNS roster maintained by the contact investigators.

    • State databases – TIMS, and state laboratory database.


Tarrant county

Tarrant County

  • Fort Worth is Central City

  • County population over 1.5 million

  • Tuberculosis program

    • Central Clinic

    • DOT and Contact Investigation centralized

    • Growing immigrant population

    • Site for several TB research projects


Dhhs region 2 3

DHHS Region 2/3

  • 37 rural counties without Public Health Departments.

  • Central office in Arlington, TX

  • Sub-Offices staffed by PH nurses

  • TB program case-managed by nurses

  • Contact investigation by nurses

  • DOT by PH and contracted nurses


Selected results tarrant co

Selected Results – Tarrant Co.

  • TB suspects who received visit within 3 working days – 65%

  • TB suspects with completed evaluation within two weeks – 91%

  • TB cases receiving Directly Observed Therapy (DOT) – 100%

  • TB cases who completed DOT – 99%


Tarrant co results continued

Tarrant Co. Results (continued)

  • TB cases with documented HIV status – 94%

  • TB cases without any identified contacts – 4%

  • Contacts with completed TB skin tests

    • With night shelter cases – 86%

    • Without night shelter cases – 57%


Selected region 2 3 preliminary results

Selected Region 2/3 PreliminaryResults

  • TB suspects who received visit within 3 working days – 63%

  • TB suspects with completed evaluation within two weeks – 78%

  • TB cases receiving Directly Observed Therapy (DOT) – 90%

  • TB cases who completed DOT – 89%


Selected region 2 3 preliminary results continued

Selected Region 2/3 Preliminary Results (continued)

  • TB cases with documented HIV status – 50% (4/10 refused test)

  • TB cases without identified contacts – 0%

  • TB contacts with completed TB skin tests – 55%


Evaluating tuberculosis surveillance and action in an urban and rural setting

Conclusions

  • Few of the national TB goals were not only met but exceeded.

    • National TB goal 4 - The national TB goal of at least 75% of all newly reported TB cases will have the HIV status reported (TC).

    • National TB goal 5 - At least 90% of patients with newly diagnosed TB, for whom therapy for one year or less is indicated, will complete therapy within 12 months (TC). 89% in R2/3.

    • National TB goal 7 - At least 90% of newly reported sputum AFB-smear positive TB cases will have contacts identified.


Evaluating tuberculosis surveillance and action in an urban and rural setting

  • One activity amenable for intervention was the activity of ‘contact investigation’. An audit of 280 TB 341 forms revealed that only 25 (8.9%) of the TB 341 forms had all the data fields completed/updated.

  • One of the national TB goals that was not achieved pertained to the activity of contact investigation –

    • National goal 8 - At least 95% of contacts to sputum AFB-smear positive TB cases will be evaluated for infection and disease (TC).

    • National goal 4 – At least 75% of cases will have HIV status known. In Reg 2/3 four out of 10 refused test.


Recommendations

Recommendations

  • Have an Integrated data base**

  • Designate a separate ‘medical records clerk’ to update the TB 340s and TB 341s. (TC)

  • Cross train staff for contact info update (TC).

  • Improve communication between the contact investigators and the clinic staff (TC).

  • Conduct either a patient satisfaction survey or focus group involving patients to obtain feedback regarding the services provided by the program.


Evaluating tuberculosis surveillance and action in an urban and rural setting

Recommendations (cont’d)

  • Educate the contacts of the cases regarding the importance of preventive therapy.

  • Streamline the process so that intake process and clinical evaluation can occur on the same day.

  • Review process for patients visiting the medical clinic for different services to reduce wait time for the patients (TC).

  • Increase follow-up for 2nd TST (R2/3).

  • More field staff for Region 2/3 – nurses, administrative, and contact investigators.


  • Login