Session 3: Assessment & Evaluation - PowerPoint PPT Presentation

NCIRD, CDC

• 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

• 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/

• 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

• Laboratory reporting audits
• Hospital record reviews
• Hospital policy surveys
• Expected births to HBsAg+ women
• Assessing case management
• Monitoring birth dose

• 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

• 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

• A CDC tool available at:

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

• 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

=

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

• 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

• 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

• Tool available in Guide to Life (Table 2.1)

• http://www.cdc.gov/ncidod/diseases/
• hepatitis/resource/perinatalhepB.htm

• 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

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

• 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)

• Date/time of HBIG
• Other variables as appropriate

• 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

• 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

• 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

• 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

• 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

• 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)

• 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

• 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

• Determine future direction and focus of program efforts
• Provide feedback to:
• hospitals
• laboratories
• providers
• health departments
• case workers