Evaluation Project Sputum Culture Conversion Illinois 2010-2014

1. Evaluation ProjectSputum Culture ConversionIllinois 2010-2014 Carrie Storrs RN, MPH, CPH Illinois Department of Public Health

2. Illinois TB Program • Illinois excluding Chicago • 102 counties with local health departments and/or local TB boards • Locally funded; funding and services vary widely • Resources for sputum induction in only a few areas • Cases treated by PMDs in many areas • IDPH: surveillance, oversight & consultation • No regulatory authority over local programs • Testing by IDPH lab at no cost to programs or providers • DOT grants to six highest incidence areas

3. Evaluation Focus Selection • Review of program performance on NTIP and other indicators • Prioritize problem areas • Performance areas lacking national targets • State and local resources • Anecdotal information related to problem areas • Feasibility of demonstrating improvement

4. Background • National target: 61.5% of sputum culture positive cases will have documentation of sputum culture conversion within 60 days by 2015 • Performance had decreased steadily • 57.1% in 2004 • 37.1% in 2008 • New web-based TB reporting system implemented in 2008 • TB control in Illinois’ largest local jurisdiction moved from a specially (and well) funded TB San District to the county health department in 2007

5. Purpose of Evaluation • Improve patient outcome (response to treatment), as indicated by an increase in the percentage of sputum culture positive cases with documentation of sputum culture conversion within 60 days • Analyze data to determine scope and nature of problem • Explore strategies to improve program performance

6. Objectives • By 12/31/2009 data will be collected, and by 5/31/10 data will be analyzed to identify the nature and scope of the problem and identify contributing factors and barriers. • By August 30, 2010 an evaluation team meeting will be held to review the data analysis and to identify and develop strategies to increase documentation of sputum culture conversion within 60 days of treatment initiation. • Increase the percentage of sputum culture positive cases with documentation of sputum culture conversion within 60 days to 50% by 2015 • 44.5% by 2010 • 46% by 2011 • 47% by 2012 • 48% by 2013 • 49% by 2014.

7. Activities • 2008 data for comparison • Review quantitative & qualitative data • Team meetings to develop strategies • Revise case & cohort review tools and emphasize sputum culture conversion in reviews • Provide education at regional meetings, workshops, during case consults, etc. • Evaluation focus and rationale • Strategies and barriers • Ongoing monitoring of surveillance data for completeness • Develop reports in web based reporting system

8. Tools

9. Tools

10. Tools – Case/Cohort Review Form

11. Results • Nature of problem • Completeness of documentation • Accuracy of documentation • Some lack of sputum collection, usually due to patient unable to produce • Patients with extensive disease • 2008 conversion increased from 37.1% to 50.2% • Cases lacking documentation decreased from 34.7% to 6.4% • 2009 conversion 61.3% • Exceeded 5 year program target in first year • Near National 2015 target of 61.5%

12. Results – 2009 cases

13. Results - 2010

14. Conclusion • With improved accuracy & completeness of documentation, objectives were exceeded • Remaining barriers likely to remain unresolved • Priority shifted to other performance targets • Decision to change evaluation focus