COHORT REVIEW: Simulation Exercise The TB Cohort Review Process Manchester, NH June 16, 2010

1. COHORT REVIEW:Simulation ExerciseThe TB Cohort Review Process Manchester, NHJune 16, 2010

2. Two Groups Face-to-face meeting Remote communication

3. Before lunch. . . • Identify people to play key roles of • Program Manager • Medical Director • Epidemiologist/Data Analyst • Supervisor • Case Managers • Get organized and prepare for cohort review this afternoon • Meet at 12:00 to discuss progress

4. After lunch . . . Review 10 TB cases in a group setting with the following information presented on each case by the case managers: • Patient's demographic information • Patient’s status: clinical, lab, radiology • Drug regimen, adherence, completion • Results of contact investigation Individual outcomes will be assessed.

5. Groupoutcomes will also be assessed. (You will practice this later in the afternoon.) Indicators track progress toward national, state, and local program objectives. • Everyone leaves the meeting knowing the results. • Discuss experience, compare models.

6. What it might look like Projection of TB Registry____________________________________________________________________ • DATA PROGRAM MEDICAL • ANALYST MANAGER DIRECTOR FILES SUPERVISOR PRESENTERS Case managers, public health nurses, disease control investigators, DOT workers, etc.

7. Cohort Review Process PROGRAM MANAGER will call for each case to be presented, ask questions to make sure treatment and contact investigation went well, and decide disposition. The Manager will also ask questions of clarification and prompt for details of staff efforts to interview, trace if lost, identify contacts, etc. CASES are called in a pre-determined order that allows DOT staff and clinic nurses to return to work ASAP. FILES will be slowly transferred from one pile to the other – as cases are called, presented, and discussed.

8. Cohort Review Process EPI/DATA ANALYST: Will record new information, tally results, note down issues needing follow-up, and present a summary of outcomes at the end. MEDICAL DIRECTOR will provide oversight and technical assistance; he/she knows the cases from the clinic in detail, having participated in medical management. He/she can explain out-of-the-ordinary clinical details. SUPERVISOR of a given clinic/region knows the cases in detail, having supported staff in case management and participated in mock cohort reviews. He/she can explain out-of-the-ordinary details.

9. Sample Agenda • Summary of characteristics of patients in this cohort • Cohort Review in the following order: ·Cases managed by DOT staff ·Cases managed at DOHMH clinics ·Cases managed by field staff 3. Summary of Outcomes from this Quarter 4. Summary of treatment outcomes for cases “likely to complete treatment” from 6 months ago 5. Summary of treatment outcomes for contacts of cases treated 9 months ago

10. Two Groups Face-to-face meeting • Nancy Hughes • Susan Nutini • Karen Pope • Cecile Martin • Michael Gosciminski • Carol Browning • Heidi Jenkins • Jill Fournier • Ted Hensley • Andrew Tibbs • Eileen Bosso • Pat Iyer • Nancy Thayer • Sally Cheney Remote communication • Josh Moses • Ijeoma Agulefo • Amy Robbins • Adriene Whitaker • Susan Schoenfeld • Carolyn Harris • Bill Dumas • Kathy Hursen • Carmen Laorenza • Myrna Lepier • Min Yao • Maura McGarty • Sharon Sharnprapai