Improved Outcomes Found after Implementing a Systematic Evaluation and Program Improvement Process for Tuberculosis

Cass, Anne; Shaw, Tambi; Ehman, Melissa; Young, Jan; Flood, Jennifer; Royce, Sarah

doi:10.1177/003335491312800507

Cited by 9 publications

(5 citation statements)

References 7 publications

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“…Despite barriers, improvement is possible and has been demonstrated by California TB control programs that systematically and routinely review PMP-managed patients during case conferences. [41] Health departments have reported success in working with PMPs on TB prevention when HDs have administrative support, have a toolkit of educational information, protocols and forms, and work to develop relationships with PMPs in the community. Alerts generated by electronic health records that could trigger PMP action such as collecting sputum or notifying the HD may also contribute to success.…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis Treatment Managed by Providers outside the Public Health Department: Lessons for the Affordable Care Act

2014

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IntroductionTuberculosis (TB) requires at least six months of multidrug treatment and necessitates monitoring for response to treatment. Historically, public health departments (HDs) have cared for most TB patients in the United States. The Affordable Care Act (ACA) provides coverage for uninsured persons and may increase the proportion of TB patients cared for by private medical providers and other providers outside HDs (PMPs). We sought to determine whether there were differences in care provided by HDs and PMPs to inform public health planning under the ACA.MethodsWe conducted a retrospective, cross-sectional analysis of California TB registry data. We included adult TB patients with culture-positive, pulmonary TB reported in California during 2007–2011. We examined trends, described case characteristics, and created multivariate models measuring two standards of TB care in PMP- and HD-managed patients: documented culture conversion within 60 days, and use of directly observed therapy (DOT).ResultsThe proportion of PMP-managed TB patients increased during 2007–2011 (p = 0.002). On univariable analysis (N = 4,606), older age, white, black or Asian/Pacific Islander race, and birth in the United States were significantly associated with PMP care (p<0.05). Younger age, Hispanic ethnicity, homelessness, drug or alcohol use, and cavitary and/or smear-positive TB disease, were associated with HD care. Multivariable analysis showed PMP care was associated with lack of documented culture conversion (adjusted relative risk [aRR] = 1.37, confidence interval [CI] 1.25–1.51) and lack of DOT (aRR = 8.56, CI 6.59–11.1).ConclusionWhile HDs cared for TB cases with more social and clinical complexities, patients under PMP care were less likely to receive DOT and have documented culture conversion. This indicates a need for close collaboration between PMPs and HDs to ensure that optimal care is provided to all TB patients and TB transmission is halted. Strategies to enhance collaboration between HDs and PMPs should be included in ACA implementation.

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Section: Discussionmentioning

confidence: 99%

Tuberculosis Treatment Managed by Providers outside the Public Health Department: Lessons for the Affordable Care Act

2014

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“…Performance (11)(12)(13)(14)18,(22)(23)25,32,34) Effects (17,(26)(27)30,40) Process (15)(16) Impact (20,31,(35)(36) Quality (11,38) Deployment (10,41) Integrity and reliability (39) Efficiency (28) Results (33) Feasibility and effectiveness (21,37) Cost and impact (29) Cost and effectiveness (24) Process (11,15,19,37) Result (12,14,(17)(18)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)…”

Section: Type Of Evaluation Dimension Evaluated Evaluation Levelmentioning

confidence: 99%

Strategies for the evaluation of interventions for the control of tuberculosis: integrative review

et al. 2019

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Objective: Identifying the available evidence in the scientific literature about the strategies used in the evaluations of interventions for the control of tuberculosis. Method: Integrative review with searches in databases Lilacs, CINAHL and PubMed in August 2017. Thirty-three articles were selected and the theoretical referential of health assessment was used for analysis. Results: The prevalent interventions were health programs (60.7%), 69.7% focusing on results and 81.9% having quantitative character (81.9%). Final considerations: The evaluation of interventions for the control of tuberculosis is beneficial for the health services’ users and aids in the decision making of managers and health professionals.

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“…Each national TB program indicator has an associated performance target. Together, these tools help programs assess the effectiveness of TB control activities and identify areas for improvement, thus improving TB patient outcomes ( 5 , 6 ).…”

Section: Introductionmentioning

confidence: 99%

Progress Toward Tuberculosis Elimination and Tuberculosis Program Performance — National Tuberculosis Indicators Project, 2016–2022

Woodruff,

Pratt,

Kolasa

2024

MMWR Surveill. Summ.

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Problem/Condition Elimination of tuberculosis (TB) is defined as reducing TB disease incidence in the United States to less than 1 case per million persons per year. In 2022, TB incidence in the United States was 2.5 TB cases per 100,000 persons. CDC’s TB program developed a set of national TB indicators to evaluate progress toward TB elimination through monitoring performance of state and city TB program activities. Examining TB indicator data enables state- and city-level TB programs to identify areas for program evaluation and improvement activities. These data also help CDC identify states and cities that might benefit from technical assistance. Period Covered The 5-year period for which the most recent data were available for each of five indicators: 1) overall TB incidence (2018–2022), 2) TB incidence among non–U.S.-born persons (2018–2022), 3) percentage of persons with drug susceptibility results reported (2018–2022), 4) percentage of contacts to sputum acid-fast bacillus (AFB) smear-positive TB patients with newly diagnosed latent TB infection (LTBI) who completed treatment (2017–2021), and 5) percentage of patients with completion of TB therapy within 12 months (2016–2020). Description of System The National TB Indicators Project (NTIP) is a web-based performance monitoring tool that uses national TB surveillance data reported through the National TB Surveillance System and the Aggregate Reports for TB Program Evaluation. NTIP was developed to facilitate the use of existing data to help TB program staff members prioritize activities, monitor progress, and focus program improvement efforts. The following five indicators were selected for this report because of their importance in Federal TB funding allocation and in accelerating the decline in TB cases: 1) overall TB incidence in the United States, 2) TB incidence among non–U.S.-born persons, 3) percentage of persons with drug susceptibility results reported, 4) percentage of contacts to sputum AFB smear-positive TB cases who completed treatment for LTBI, and 5) percentage of patients with completion of TB therapy within 12 months. For this report, 52 TB programs (50 states, the District of Columbia, and New York City) were categorized into terciles based on the 5-year average number of TB cases reported to National TB Surveillance System. This grouping allows comparison of TB programs that have similar numbers of TB cases and allocates a similar number of TB programs to each category. The following formula was used to calculate the relative change by TB program for each indicator: [(% from year 5 − % from year 1 ÷ % from year 1) × 100]. Results During the 5-year period for which the most recent data were available, most TB programs had improvements in reducing overall TB incidence (71.2%) and increasing the percentage of contacts receiving a diagnosis of LTBI who completed LTBI treatment (55.8%); the majority of programs (51.0%) also had improvements...

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Improved Outcomes Found after Implementing a Systematic Evaluation and Program Improvement Process for Tuberculosis

Cited by 9 publications

References 7 publications

Tuberculosis Treatment Managed by Providers outside the Public Health Department: Lessons for the Affordable Care Act

Tuberculosis Treatment Managed by Providers outside the Public Health Department: Lessons for the Affordable Care Act

Strategies for the evaluation of interventions for the control of tuberculosis: integrative review

Progress Toward Tuberculosis Elimination and Tuberculosis Program Performance — National Tuberculosis Indicators Project, 2016–2022

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