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Evaluation of Completion of Treatment for Tuberculosis in New York State

Evaluation of Completion of Treatment for Tuberculosis in New York State. Cheryl H. Kearns, MPH. Background/Timeline. Summer 2004 Evaluation required as part of Cooperative Agreement

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Evaluation of Completion of Treatment for Tuberculosis in New York State

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  1. Evaluation of Completion of Treatment for Tuberculosis in New York State Cheryl H. Kearns, MPH

  2. Background/Timeline Summer 2004 • Evaluation required as part of Cooperative Agreement • Task Order 15: Enhancing TB Programs’ Capacity for Self-Evaluation: Testing New Tools and Developing an Evaluation Toolkit

  3. Background/Timeline Fall/Winter 2004-2005 • TO 15 – Guide to Developing an Evaluation Plan

  4. Background/Timeline April 2005 New York State Evaluation Plan finalized • Retrospective look at National Objective Performance for 2000-2005 • Identify areas of strength and weakness • Meet with counties

  5. Completion of Treatment in New York State (Exclusive of New York City)

  6. Percent of Cases Who Complete Treatment within 12 Months by Morbidity 2000-2004* * Of those eligible to complete within 12 months. Source: New York State Department of Health Bureau of Tuberculosis Control

  7. Percent of Cases Who Complete Treatment within 12 Months By County for those with Average >= 5 Cases, 2000-2004* * Of those eligible to complete within 12 months. Source: New York State Department of Health Bureau of Tuberculosis Control

  8. TB Elimination for NY State Outcomes Inputs Outputs Activities Short - term Intermediate Long - term Capacity and Effective Reduced TB Coordinat ion and infrastructure Developing and transmission communicat ion setting policy · Adequate with providers funding · Timely com - · Strong and well - pletion of staffed state Patients appropriate Educat e providers and program treatment Educated Reduced LTBI community · Local health prevalence Obj1: Increase e % departments, Obj 6: TB patients hospitals, Reduce TB Test for drug Find and treat active complete therapy case rate medical Prescribe susceptibility TB among African providers appropriate Obj 3B: Find cases early American · therapy Functional data Increase infected Reduce barriers Test for HIV systems, contacts completed tx including case · Patient management adheres to Obj 4: data system Contacts Reduced TB Patients on treatment Increa se infected · Adequate Identified incidenc e appropriate high - risk Investigate Contacts physical, a nd evaluated T reatment completed tx Obj 2: diagnostic, and Obj 3A: Increase % treatment Obj 5B: Increase Reduced TB contacts resources Increase % infected morbidity and evaluated Foreign born · Policies, contact mortality treated procedures, s placed on and guidelines Immigrants and tx Prevent TB in high - refugees with risk populations A/B1/B2 status · Engage community l ocated and partners Improved quality of evaluated · Detect LTBI & TB patient life Obj 5 A : Increase % Fo reign born evaluated Monitoring & African evaluation American patients Development of an Elimination identified and evaluation plan for evaluated state/local level of TB Enhanced evaluation accountabili ty

  9. Meet with Counties • Present county performance graphs • Encourage counties to evaluate performance

  10. Task Order 15 • NYSDOH develops Chart Abstraction Tool • Hire local nurses familiar with record system • Project nurses gather data on Chart Abstraction Forms • NYSDOH data entry, analysis • NYSDOH analysis to Counties / CDC / TBESC

  11. Chart Abstraction Tool • 109 Questions • 20 sections • Hospitalization • Airborne Isolation • Symptom review • Social needs • Language • Medical needs • Outreach Worker Information • Patient Education • Reporting and Documentation

  12. Implementation • Training and Pilot of Chart Abstraction tool • September 2005 • Data Collection • October 2005-April 2006 • Nassau (53 Cases) • Suffolk (61 Cases) • Data Analysis • May 2006 – September 2006

  13. Analysis • 112 Charts were reviewed • 103 had COT info • 85 (82.5%) completed within 12 months • 18 (17.5%) did not complete within 12 months

  14. Reasons for Not Completing • Prolonged culture positive • Rifampin Resistance • Pregnant and could not tolerate Rifampin • Comorbid conditions requiring extended regimen • Died while on treatment • Moved • Vacation

  15. Interventions • 9 months on treatment email • National Objectives added to county contracts • Cohort review

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