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COHORT REVIEW: Principles and Models The TB Cohort Review Process Manchester, NH June 16, 2010

COHORT REVIEW: Principles and Models The TB Cohort Review Process Manchester, NH June 16, 2010. Cooperative Agreement. Activities for Program Evaluation:

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COHORT REVIEW: Principles and Models The TB Cohort Review Process Manchester, NH June 16, 2010

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  1. COHORT REVIEW:Principles and ModelsThe TB Cohort Review Process Manchester, NHJune 16, 2010

  2. Cooperative Agreement Activities for Program Evaluation: • To improve TB case management and program accountability and feedback, the grantees should hold quarterly cohort reviews at the state or local levels or both. Cohort reviews are integral to TB control and they provide a systematic review of the management of cases and contact investigations.

  3. Instruction Guide Instructions on cohort reviews, definitions, roles of staff, timelines, core elements, and guidance on tailoring the process to your program are published in the CDC document, "Understanding the TB Cohort Review Process: Instruction Guide.“ www.cdc.gov/tb/education/cohort.htm www.cdc.gov/tb/publications/guidestoolkits/cohort/Cohort.pdf

  4. Cooperative Agreement • Also refer to International Journal of Tuberculosis and Lung Disease, 2006 October, 10(10) 1133-9; Title “Ensuring accountability: the contribution of the cohort review method to TB control in NYC”, New York City Department of Health and Mental Hygiene, New York, New York, 10007 USA. • Grantees should report the progress on conducting cohort reviews, including number of cases discussed, key issues identified during these cohort reviews and recommendations provided. Additionally progress on implementing these recommendations should also be included in the progress reports

  5. Cohort Review:A systematic review of the management of patients with TB disease and their contacts. A “cohort” is a group of TB cases counted over a specific period of time, usually 3 months. TB cases are reviewed for the patient’s clinical status, the adequacy of the medication regimen, treatment adherence or completion, and the results of contact investigation Case Review: A part of case management. Systematic regular review of patient progress presented by the health department employee primarily responsible for managing that case. Plans are made to address any barriers to adherence. Definitions

  6. Principles and Process • Systematic review of outcomes • Patients with disease and their contacts • Confirmed cases counted over a period of time • Review clinical status, adequacy of medication regimen, treatment adherence or completion, results of contact investigation – and timeliness measures if so desired • Immediate analysis and feedback to group • Compare to national and local objectives

  7. What is reviewed? (1) TB cases are reviewed in a group setting with the following information presented on each case by the case manager: • Patient's demographic information • Patient’s status: clinical, lab, radiology • Drug regimen, adherence, completion • Results of contact investigation Individual outcomes are assessed.

  8. What is reviewed? (2) • Groupoutcomes are also assessed. • Indicators track progress toward national, state, and local program objectives. • Everyone leaves the meeting knowing the results.

  9. Roles Roles of staff are detailed in the CDC Instruction Guide: • TB Program Manager • Medical Director • Epidemiologist/Data Analyst • Supervisor • Case Managers

  10. Quarter Case Identified Quarter Case Reviewed 1st (Jan-Mar 09) 4th (Oct-Dec 09) 2nd (Apr-Jun 09) 1st (Jan-Mar 10) 3rd (Jul-Sep 09) 2nd (Apr-Jun 10) 4th (Oct-Dec 09) 3rd (Jul-Sep 10) Timeline Example of a Cohort Review Schedule

  11. Three Steps • PREPARATION • PRESENTATION • FOLLOW-UP

  12. Cookie cutter or a set of principles? Cohort Review is NOT a cookie cutter approach!

  13. Every program area is different, but the principles remain the same.

  14. Current Models of the TB Cohort Review Process

  15. One size does not fit all! Approach must be tailored to account for urban areas and program size.

  16. Who is doing it? County City State

  17. Rochester 585-423-8059 Syracuse 315-477-8101 Troy 518-408-5396 New Rochelle 914-654-7154 Buffalo 716-847-4509 New York City 212-417-4886 Hauppauge 631-851-3094 Bureau of Tuberculosis Control County and Regional Assignments by TB Representative Clinton Franklin St Lawrence Essex Jefferson Lewis Hamilton Warren Oswego « Orleans Washington « Oneida Niagara Wayne Saratoga Fulton Monroe Herkimer Genesee « Onondaga Montgomery Seneca Schenectady « Ontario Madison Wyoming Cayuga Erie Livingston Yates Albany Otsego Cortland Rensselaer Schoharie Chenango Tompkins Schuyler Allegany Greene Chautauqua Columbia Cattaraugus Delaware Steuben Tioga Chemung Broome Ulster Dutchess Sullivan Bronx « New York Putnam Orange Queens Westchester « Rockland Kings « Suffolk « Richmond New York City Nassau Rev. 4/8/05

  18. Is this in our future?

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