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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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Presentation Transcript
learning objectives
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
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
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
Overview
  • Laboratory reporting audits
  • Hospital record reviews
  • Hospital policy surveys
  • Expected births to HBsAg+ women
  • Assessing case management
  • Monitoring birth dose
laboratory reporting audits
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
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
Laboratory Audit Tool
  • A CDC tool available at:

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

completeness of lab reporting
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 cont d
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
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
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
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
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
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
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
Hospital Data to Collect- cont’d
  • Date/time of HBIG
  • Other variables as appropriate
hospital policy surveys
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
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
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
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
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
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
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
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
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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