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COHORT REVIEW: Principles and Models The TB Cohort Review Process Manchester, NH June 16, 2010. Cooperative Agreement. Activities for Program Evaluation:

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Cohort review principles and models the tb cohort review process manchester nh june 16 2010

COHORT REVIEW:Principles and ModelsThe TB Cohort Review Process Manchester, NHJune 16, 2010


Cooperative agreement
Cooperative Agreement

Activities for Program Evaluation:

  • To improve TB case management and program accountability and feedback, the grantees should hold quarterly cohort reviews at the state or local levels or both. Cohort reviews are integral to TB control and they provide a systematic review of the management of cases and contact investigations.


Instruction guide
Instruction Guide

Instructions on cohort reviews, definitions, roles of staff, timelines, core elements, and guidance on tailoring the process to your program are published in the CDC document, "Understanding the TB Cohort Review Process: Instruction Guide.“

www.cdc.gov/tb/education/cohort.htm

www.cdc.gov/tb/publications/guidestoolkits/cohort/Cohort.pdf


Cooperative agreement1
Cooperative Agreement

  • Also refer to International Journal of Tuberculosis and Lung Disease, 2006 October, 10(10) 1133-9; Title “Ensuring accountability: the contribution of the cohort review method to TB control in NYC”, New York City Department of Health and Mental Hygiene, New York, New York, 10007 USA.

  • Grantees should report the progress on conducting cohort reviews, including number of cases discussed, key issues identified during these cohort reviews and recommendations provided. Additionally progress on implementing these recommendations should also be included in the progress reports


Definitions

Cohort Review:A systematic review of the management of patients with TB disease and their contacts. A “cohort” is a group of TB cases counted over a specific period of time, usually 3 months. TB cases are reviewed for the patient’s clinical status, the adequacy of the medication regimen, treatment adherence or completion, and the results of contact investigation

Case Review: A part of case management. Systematic regular review of patient progress presented by the health department employee primarily responsible for managing that case. Plans are made to address any barriers to adherence.

Definitions


Principles and process
Principles and Process

  • Systematic review of outcomes

  • Patients with disease and their contacts

  • Confirmed cases counted over a period of time

  • Review clinical status, adequacy of medication regimen, treatment adherence or completion, results of contact investigation – and timeliness measures if so desired

  • Immediate analysis and feedback to group

  • Compare to national and local objectives


What is reviewed 1
What is reviewed? (1)

TB cases are reviewed in a group setting with the following information presented on each case by the case manager:

  • Patient's demographic information

  • Patient’s status: clinical, lab, radiology

  • Drug regimen, adherence, completion

  • Results of contact investigation

    Individual outcomes are assessed.


What is reviewed 2
What is reviewed? (2)

  • Groupoutcomes are also assessed.

  • Indicators track progress toward national, state, and local program objectives.

  • Everyone leaves the meeting knowing the results.


Roles
Roles

Roles of staff are detailed in the CDC Instruction Guide:

  • TB Program Manager

  • Medical Director

  • Epidemiologist/Data Analyst

  • Supervisor

  • Case Managers


Timeline

Quarter Case Identified

Quarter Case Reviewed

1st (Jan-Mar 09)

4th (Oct-Dec 09)

2nd (Apr-Jun 09)

1st (Jan-Mar 10)

3rd (Jul-Sep 09)

2nd (Apr-Jun 10)

4th (Oct-Dec 09)

3rd (Jul-Sep 10)

Timeline

Example of a Cohort Review Schedule


Three steps
Three Steps

  • PREPARATION

  • PRESENTATION

  • FOLLOW-UP


Cookie cutter or a set of principles
Cookie cutter or a set of principles?

Cohort Review is NOT a cookie cutter approach!



Current models of the tb cohort review process
Current Models of the the same.TB Cohort Review Process


One size does not fit all
One size does not fit all! the same.

Approach must be tailored to account for urban areas and program size.


Who is doing it
Who is doing it? the same.

County

City

State


Rochester the same.

585-423-8059

Syracuse

315-477-8101

Troy

518-408-5396

New Rochelle

914-654-7154

Buffalo

716-847-4509

New York City

212-417-4886

Hauppauge

631-851-3094

Bureau of Tuberculosis Control

County and Regional Assignments

by TB Representative

Clinton

Franklin

St Lawrence

Essex

Jefferson

Lewis

Hamilton

Warren

Oswego

«

Orleans

Washington

«

Oneida

Niagara

Wayne

Saratoga

Fulton

Monroe

Herkimer

Genesee

«

Onondaga

Montgomery

Seneca

Schenectady

«

Ontario

Madison

Wyoming

Cayuga

Erie

Livingston

Yates

Albany

Otsego

Cortland

Rensselaer

Schoharie

Chenango

Tompkins

Schuyler

Allegany

Greene

Chautauqua

Columbia

Cattaraugus

Delaware

Steuben

Tioga

Chemung

Broome

Ulster

Dutchess

Sullivan

Bronx

«

New York

Putnam

Orange

Queens

Westchester

«

Rockland

Kings

«

Suffolk

«

Richmond

New York City

Nassau

Rev. 4/8/05



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