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Lisa Jacques-Carroll, MSW NCIRD, CDC. Session 3: Assessment & Evaluation. Learning Objectives. Describe key components of evaluation of a perinatal hepatitis B prevention program describe different methods for assessing and evaluating a perinatal hepatitis B prevention program

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Session 3: Assessment & Evaluation

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Lisa Jacques-Carroll, MSW

NCIRD, CDC

Session 3: Assessment & Evaluation


Learning Objectives

  • Describe key components of evaluation of a perinatal hepatitis B prevention program

    • describe different methods for assessing and evaluating a perinatal hepatitis B prevention program

    • identify several tools that are available


Assessment & Evaluation

  • Program evaluation vs. program monitoring or assessment

  • The focus of this session is on assessing performance measures, which is a component of program evaluation

  • For more information on program evaluation see: 

    www.cdc.gov/vaccines/programs/progeval/


Activities Required by CDC

  • Requirements for assessment of the perinatal hepatitis B include:

    • frequency of assessment

    • performance measures

    • target levels

  • For more information:

    http://www.cdc.gov/vaccines/vac-gen/policies/ ipom/downloads/chp-05-perinatal-hepb.pdf


Overview

  • Laboratory reporting audits

  • Hospital record reviews

  • Hospital policy surveys

  • Expected births to HBsAg+ women

  • Assessing case management

  • Monitoring birth dose


Laboratory Reporting Audits

  • Use to assess:

    • completeness of reporting of HBsAg+ results

    • timeliness of reporting

  • Include delivery hospital labs

  • Collaborate with communicable disease and state laboratory staff to help plan and execute reviews


Prioritize Labs to Evaluate

  • Priority labs:

    • labs serving high-morbidity areas or populations

    • labs reporting large volume of hepatitis serology

    • labs serving prenatal clinics

    • delivery hospital labs

  • How often?

    • ideally, once/year for priority labs

    • every 2–3 years for others

    • minimally every 5 years


Laboratory Audit Tool

  • A CDC tool available at:

http://www.cdc.gov/ncidod/diseases/hepatitis/resource/LabReportingAssessment.doc


Completeness of Lab Reporting

  • Pick a time period (at least 3 months)

  • Calculate:

Total # HBsAg+ test results reported

Total # specimens that were HBsAg+

Proportion of HBsAg+ tests reported, or

completeness of reporting

=


Timeliness of Lab Reporting


Timeliness of Lab Reporting - cont’d

Sum of column “# days

between serology and report”

Total # of serologies evaluated

Mean reporting time for the laboratory,

or timeliness of reporting

=

25

4

=

6.25 days

e.g. from the

previous slide

Time period for reporting is typically set by state statute


Tips for Working with Laboratories

  • Contact other areas of health department to see if activity is already being done

  • See if an existing lab report can be used for the audit—ensure it is source data

  • When making contact with labs, include:

    • lab director

    • technician

    • IT staff


Hospital Record Reviews

  • Use to assess:

    • maternal HBsAg screening

    • birth dose administration

    • post-exposure prophylaxis (PEP) for infants born to HBsAg+ and unknown-status women

  • Audit paired maternal and infant records

  • Partner with health dept programs to collect other perinatal data

    • rubella antibody• HIV

    • group B strep• early hearing

    • syphilis


Determining Sample Size

  • Tool available in Guide to Life (Table 2.1)

  • http://www.cdc.gov/ncidod/diseases/

  • hepatitis/resource/perinatalhepB.htm


Using the Guide to Life table

  • Determine hospital’s annual number of deliveries

  • Decide where it falls in the “Birth Cohort Size” category

  • Estimate HBsAg screening and hepatitis B birth dose coverage for the hospital

  • Use the lower coverage to determine the sample size


Sample Size Example

Hospital X had 648 deliveries last year

The expected HBsAg screening rate is 95%

The state National Immunization Survey (NIS) birth dose rate is 65%

Using the 65% coverage level, the sample size for Hospital X would be 111 records


Hospital Data to Collect

  • Delivery date/time

  • Mother’s HBsAg test date/result/type in:

    • maternal record

    • infant record

  • Infant hepatitis B vaccination (yes/no)

  • Date/time of vaccination

  • Infant HBIG administration (yes/no)


Hospital Data to Collect- cont’d

  • Date/time of HBIG

  • Other variables as appropriate


Hospital Policy Surveys

  • Use to assess whether hospitals have written policies/standing orders in place:

    • universal birth dose of hep B

    • HBsAg screening of pregnant women

    • PEP to infants born to HBsAg+ and unknown-status women

    • documentation of maternal HBsAg status, birth dose, and HBIG (if appropriate) in medical records


Conducting Policy Surveys

  • Mail survey

  • Telephone survey

  • In-person survey

    during hospital

    medical record

    reviews

Keep in mind, policies do not always match practice,

so medical record reviews are essential


Expected Births to HBsAg+ Women

  • CDC expected birth estimates are a benchmark for programs

  • CDC provides estimates for states and some cities

  • Estimates are calculated using:

    • birth data

    • prevalence of chronic

      HBV infection by

      race/ethnicity


Expected Births- cont’d

  • Nationally, about 24,000 births expected annually, only 50% identified in 2005

  • CDC encourages programs to improve estimates of births to HBsAg+ women

  • More information in presentation at:

    http://www.cdc.gov/ncidod/diseases/hepatitis/resource/presentations/2007-04PeriGrantees/PDFs/May1-p0130-1LJ_2007PeriCoordMtg-ExpectedBirths.pdf


Assessing Case Management

  • Number of infants born to HBsAg+ women

  • Proportion of infants receiving

    • hep B vaccine & HBIG within 12 hours of birth

    • on-time completion of hep B vaccine series

    • post-vaccination testing

  • Reasons for cases lost to follow-up

  • Proportion of screened and vaccinated household and sexual contacts


Assessing Case Mgmt - cont’d

  • Monitor case management outcomes:

    • compare program-wide rates (entire state or city) to national rates (CDC peritable)

    • regionally

    • locally (county level)

    • by case worker

    • quarterly or monthly

    • over time (trends)


Monitoring Birth Dose

  • National Immunization Survey (NIS) data

    • measures hepatitis B birth dose rates

  • Hospital medical record reviews

  • Immunization Information Systems (IIS)

    • hep B vaccine birth certificate data automatically uploaded into IIS

    • calculate birth dose coverage for cities, regions, and individual hospitals


Continuous Monitoring

  • Some aspects of the program require continuous monitoring

    • case management outcomes

    • laboratory reporting

  • Plan ahead for assessments your program will conduct over the next year/s


Using Your Results

  • Determine future direction and focus of program efforts

  • Provide feedback to:

    • hospitals

    • laboratories

    • providers

    • health departments

    • case workers


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