Sherry Carlson & Sheanne AllenWashington State Department of Health- TB Program

September 2012

Redesign, Remodel, Revamp: Constructing a New Cohort Review

Process in Washington State

Objectives

Describe how to simplify and even eliminate forms for cohort review

Provide more interactive learning during the cohort review

Personalize data so it’s more relevant to local health department staff

Cohort Review CDC The cohort review is a very useful tool for ensuring accountability, informing and educating program staff about protocol and national objectives, and improving case management and prevention. To improve TB case management and program accountability and feedback, the grantees shall conduct at least one cohort review per year at the state or local levels or both. Programs should continue with ongoing case reviews as usual. Cohort Reviews should be implemented based on the guidance provided by the CDC Division of Tuberculosis Elimination (http://www.cdc.gov/tb/publications/guidestoolkits/cohort/letter.htm).

Cohort Review 2003- 20112003 – Cohort Review implemented statewide (based on the NYC model)

2010 – Cohort Review became a requirement of CDC

Late 2010 – A workgroup was formed to revise and develop an improved case management and cohort review process

Old CR model2003 – Cohort Review implemented

All day quarterly retrospective review of all cases from pre-determined time frames (9 months to 1 year before)

Mock cohort

LHJs called in or attended in-person

Epi-presentation of past data

PerspectivesRetrospective, unable to intervene and implement recommendations

Scripted and hard to follow, especially via phone

Too long to be on the phone listening to scripted case reports

WorkgroupConsisted of:

Local Health Jurisdiction (LHJ) TB staff

Medical Consultant

DOH TB Program staff

DOH State Epidemiologists

Workgroup, cont.Ideas proposed by the workgroup were:

To review cases in real-time – clinical case management oversight;Eliminate the cohort review presentation forms – capture all necessary data in Public Health Issue Management System (PHIMS) TB;Change quarterly format from retrospective case presentations to clinical review of current cases;Incorporate biannual program evaluation (based on core objectives and measures) with a cohort review of selected casesMake process more effective, efficient, and interactive

New Format OutlineTwo part process:

1) Quarterly case review QA process by DOH TB staff

2) Biannual indicator review and cohort review

Presentation of core indicators and interactive case studies

New Format Outline, Part 1

New Format Outline, Part 2

New Form

Core IndicatorsCases who complete treatment in 12 months

Sputum culture conversion

Time from sputum smear positive result to starting TB treatment

Treatment failures and relapse rates

Contacts evaluated

Contacts who start/complete treatment for LTBI

Timeline

ExpectationsLHJ:

Keep PHIMS TB data current and accurate Timely follow-up on issues from case reviews (ex. missing PHIMS data)

DOH:Monitor core indicatorsProvide and assist LHJs with follow-up tasksOffer feedback from medical expert

RevisionsNo forms - no longer reading a script! Real-time review of current casesDesignated time slots=more efficient use of LHJ timeCases may be reviewed multiple times before closure in PHIMS TBInteractive learning through selected casesDOH provides indicator data for ALL of WA StateIndicator data will also be provided for individual LHJs

Survey ResultsOur preliminary results from the spring meeting shows on question #3

I learned helpful strategies in handling my TB cases from the cohort review and will make

changes based on things I learned went from 40% saying they agreed for the old model to 90% saying they agreed when attending the new model of the Cohort Review.

November 2012 results to follow.

Perspectives “ I had stopped attending cohort review because it had become so cursory, as to not afford a good learning opportunity for me. The 2012 cohort review was a great learning experience and I look forward to next ones. Hearing the discussion of different settings and scenarios, challenges, and how different people handle situations was fascinating. There was a richness of information shared, wrap up of lessons learned and ideas for going forward to handle problems identified that made it well worth my time and rich learning experiences!”

“I just wanted to thank you (and your team) for changing the format of the Cohort review. I appreciated hearing about the other cases and thought the discussions were excellent.”

“I love the new format for the biannual cohort review. It was much more interactive, interesting and beneficial to have the open discussion at the end of the case presentations. I am so glad we are not just reading down a list of dates of this and that.”

“I appreciate the insight to the cases and comments from LHJ/state/medical staff. It seemed like more of a learning opportunity than just a presentation of a case. I like this format better. “

FutureContinue enhancements to collect complete data in PHIMS TB

Ongoing evaluation by LHJ TB Program staff

Proposed annual meeting of the workgroup

Other experiences

Questions

Contact Information

• Sheanne AllenTB Controller/Program ManagerWashington State Dept of HealthPh: 360-236-3423sheanne.allen@doh.wa.gov

• Sherry CarlsonTB Education ConsultantWashington State Dept of HealthPh: 360-236-3528sherry.carlson@doh.wa.gov