1 / 24

The Cohort Review Process in Washington State

The Cohort Review Process in Washington State. Kim Field, RN, MSN Washington State Department of Health kim.field@doh.wa.gov Website: www.doh.wa.gov/cfh/tb April 2009. WA State. WA State TB Morbidity A Medium Incidence State. Population of over 6 million; approx. 80,000 births annually

lilia
Download Presentation

The Cohort Review Process in Washington State

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. The Cohort Review Process in Washington State Kim Field, RN, MSN Washington State Department of Health kim.field@doh.wa.gov Website: www.doh.wa.gov/cfh/tb April 2009

  2. WA State

  3. WA State TB MorbidityA Medium Incidence State • Population of over 6 million; approx. 80,000 births annually • 2004 TB Data: 244 TB cases (3.9/100,000) vs. (4.9/100,000) incidence in the U.S. • Highest incidence in King County: 133 cases (7.4/100,000) • Comprised 55% of total TB cases in 2004

  4. WA State Profile: TB Funding • 39 counties comprise 34 Local Health Jurisdictions (LHJs) • 74 local TB staff including managers, PHNs, administrative, outreach workers • $890,000 of $1.4 million federal funds to 4 LHJs • $5.6 million available in local funds for LHJs

  5. 2005-2009 State TB ObjectivesA National Measurement of Our Success as a State 1999-2003 • 90% of TB patients completed a course of TB treatment within 12 months of initiation • 75% of patients were on DOT • State Objectives, by 2009 • 95% of TB patients will complete a course of TB treatment within 12 months of initiation • 85% of patients being treated for active TB will be on DOT

  6. 2005-2009 TB Objectives, Cont.A National Measurement of Our Success as a State 1999-2003 • HIV status was reported for 89% of all reported cases • Drug susceptibility results were reported for 99% of all culture-positive TB cases • State Objectives, by 2009 • HIV status will be reported for 90% of all newly reported TB cases • Drug susceptibility results will be reported for 95% of all culture-positive TB cases

  7. 2005-2009 TB Objectives, Cont.A National Measurement of Our Success as a State 1999-2003 • Contacts were identified for 82% of sputum smear+ cases • 57% of contacts to sputum smear+ cases were evaluated • 47% of infected contacts started on treatment, completed (reporting delay) • State Objectives, by 2009 • Contacts will be identified for at least 90% of sputum smear+ cases • 75% of contacts to sputum smear+ cases will be evaluated • 70% of infected contacts started on treatment will complete

  8. Impact of Cohort Review in WA StatePre (2001) and Post (2004) ImplementationCase Summary

  9. Pre (2001) and Post (2004) ImplementationContact Summary

  10. Post ImplementationCase Summary

  11. Post ImplementationCase Summary: Timeliness Measures(Washington Modification to NYC Model)

  12. Post ImplementationContact Summary

  13. Washington State Cohort Review 2007: Fourth Quarter

  14. Percentage of cases on directly observed therapy (DOT), North/South regions 91% 80%

  15. Percentage of cases offered an HIV test at time of TB screening, North/South regions 92% 90%

  16. Percentage of infectious cases (smear +) “likely to complete” medications, North/South regions 90% 89%

  17. Percentage of infectious cases lost to follow-up or refused to continue treatment after starting, North/South regions 0% 0%

  18. Median number of days between sputum collection and receipt at a lab, North/South regions

  19. Median number of days between the smear + date and LHJ report of case to DOH, North/South regions

  20. Cases: October - December 2007 North/South regions • 80% of cases completed treatment; 89% expected to complete • 11% moved or died • 3% lost • 91% were on DOT (100% for smear+) • 8% not offered an HIV test • 17% had medical adherence issues • 9% had personal adherence issues • 6% provider interrupted therapy

  21. Cases: Oct - Dec 2007North/South regions, cont’d Median Number of Days: Timeliness Measures • 3 cases had an MTD test • Of those that didn’t (n=4 smear-culture+ cases) • Median of 10 days between date sputum was collected and date they started meds • Lab Sputum Collection: 1 day • Culture Testing: 17.5 days • Susceptibility: 21 days

  22. Contacts: October – December 2007North/South regions • 139 contacts identified to 36 cases; ~8 per case, median of 5.5 • 80% of smear + cases identified contacts (2 case didn’t) • 10 smear + cases identified 86 contacts • 82% tested • 57% evaluated for TB • 21% infected • 21% infection rate (diseased + infected) • 17% were infected by didn’t start treatment • 83% of infected started treatment and of those… • 20% completed (4 contacts) • 55% currently on or not closed out in our database • 20% Provider discontinued meds (contacts to pediatric cases) (4 contacts) • 5% Moved (1 contact)

  23. Contacts and References • Kim.Field@doh.wa.gov 360-236-3447 • http://www.doh.wa.gov/cfh/TB/Manual/Forms/CohortPresentation.pdf • http://www.doh.wa.gov/cfh/TB/Manual/Forms/CohortDictionary.pdf

  24. References • S:\CFH\IDRH\TB Services\Cohort Review\Generic Forms

More Related