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Cohort Review: An Inside Look

Cohort Review: An Inside Look. Jill Brock, RN Sandi Morse, RN Wendi Hollowell, RN TB Regional Nurse Consultants April 10, 2018. What is Cohort R eview?. CDC defines a cohort r eview as, “A systematic review of the management of patients with TB disease and their contacts”

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Cohort Review: An Inside Look

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  1. Cohort Review: An Inside Look Jill Brock, RNSandi Morse, RN Wendi Hollowell, RN TB Regional Nurse Consultants April 10, 2018

  2. What is Cohort Review? CDC defines a cohort review as, “A systematic review of the management of patients with TB disease and their contacts” Cohort review is not specific to ISDH Most TB programs in the United States utilize a cohort review process to coordinate TB control efforts Cohort Review can take many forms and can be adapted to the needs of a particular program

  3. Reasons for Cohort Review Identify potential issues in case management (inappropriate regimen or inadequate number of contacts tested) and assist in determining solutions Provides a learning opportunity for all staff involved Allows consultation for difficult cases (nonadherence, MDR-TB) Allows for recognition of the intensive efforts of staff managing TB cases and contacts Evaluation of case management and effectiveness of programs Required for CDC grant

  4. Why does the TB Case Manager present? The TB case manager has a unique perspective on the case because of working so closely with patient Gives the TB case manager direct access to Dr. Allen Important for the group to hear TB case manager’s point of view so we can learn and understand Chance to identify other needed resourcesand troubleshoot issues with larger team

  5. ISDH Cohort Overview Modified Case/Cohort Review More focus on individual cases and done earlier in their therapy than a traditional cohort review Patients are reviewed during their fourth month of treatment Scheduled for the 2nd Wednesday of every month We allow a total of 10 minutes for each scheduled case presentation Approx. 7 min for TB case manager and 3 min for Dr. Allen

  6. ISDH Cohort Notification TB Epidemiologist produces a review list from our TB SWIMSS system which includes all patients, cases and suspects, in their fourth month of treatment This list is forwarded to the respective TB Regional Nurse Consultant The TB Regional Nurse Consultant will notify the TB case manager of upcoming presentation(s)

  7. Example of Email Notification Our records indicate that it is now time for _________ County patient _______________ to be reviewed by ISDH. We try to review every TB case and every open TB suspect case around 4 months after their treatment has started. This review process is done by conference call (we will call you at the specified time). We usually have the local health department PHN managing the TB case give a short presentation to Dr. Allen, who is our ISDH TB Medical Consultant along with Kelly White, TB Program Manager, Thao Sang, our epidemiologist, the regional TB nurses (Jill, Wendi and myself) and any other county nurses who may be in attendance. For the case presentation, just basically give a brief patient history, including any family history of TB , and specifically how we got to the diagnosis of TB. Then be sure to go over all the items in section One of the Chart Review Form (attached) regarding patient information. Then just follow the form section by section. Discuss the sputum smears & cultures any bronch/or other results as noted on the form in section 2. If the patient was unable to produce a sample please be sure to mention that as well. Then discuss any CXRs, CTs, etc. Also be sure to mention if the patient is pan sensitive or possibly resistant to any medications. Section 3 of the form is about the patient’s medication regimen, start date, how many weeks and doses of each medication and where we are now in treatment and the anticipated length of treatment (6,9,12 months etc.). Also be sure to mention any specific improvements you have noticed since the patient has been on treatment. The last section is about the contact investigation, first and second round testing results and if anyone was started on LTBI Window or ATB treatment. After the nurse presents the case, Dr. Allen may ask for further information or make recommendations on treatment or other things. Also, please feel free to ask Dr. Allen any other questions you may have regarding this patient at this time. The Cohort Review Conference call will be on ___________________ at ___________ ( Indianapolis, IN time) Some counties may be in different time zones, but remember the cohort time is set on Indianapolis time so proceed accordingly. The calls normally last approximately ten minutes each. WE will call you as close to the scheduled time of __________ on ____________ give or take five minutes. We try very hard to keep on schedule, but that sometimes does not work out. Our time slots are limited for that day so I am hoping the scheduled time works for you. If you could also have the patient’s most recent up to date Monthly Report faxed to ISDH (please disregard if you have already faxed), that will be very helpful for the review. I have ____________ as the contact number for you. Is this the number I should use for the day of the conference call? Thank you for your assistance. Please call or email me for any questions regarding the Cohort Patient Chart Review.

  8. Cohort Review Quality Assurance Review Each case/suspect up for cohort is reviewed by the TB Epidemiologist to identify missing data, inconsistent data, missing contact investigation information, etc. This report is submitted to the TB Regional Nurse Consultant for resolution This information is shared with the TB case manager who should then reconcile the report by the date of cohort, if possible Please notify the TB Regional Nurse Consultant if the Report of TB is updated so that the RVCT (report sent to CDC) can be updated as well

  9. What Happens on the Day of Cohort Review? Cohort Review is in a private ISDH conference room TB case manager will receive ISDH call at designated presentation time We try to stick to schedule as much as possible Present case to group Dr. Bradley Allen , TB Medical Consultant Kelly White, TB Program Manager Sang Thao, TB Epidemiologist TB Regional Nurse Consultants (Wendi, Jill, Sandi) Other misc. visitors (i.e. med & nursing students) Always welcome to present in person at ISDH

  10. Case Presentation Form

  11. Case Presentation Form

  12. Example of Case Presentation

  13. Case PresentationTips/Things to Remember Preparation is essential to presentation success Please plan ahead Sometimes it is difficult to obtain labs or arrange a visit with the RNC if you have waited until the day before cohort Please ask your regional nurse consultant if you need assistance with your cohort presentation We are happy to help  We can assist by phone or visit Stay Calm! We are all in this TOGETHER! You are not being critiqued We are all a team striving for best patient outcome

  14. Case Presentation Tips/Things to Remember Be brief (only necessary details) Speak loudly and clearly Stick to format This is a great forum for questions – Please ask any patient-related questions you might have!

  15. Questions?

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