1. Sherry Carlson & Sheanne Allen Washington State Department of Health- TB Program September 2012 Redesign, Remodel, Revamp: Constructing a New Cohort Review Process in Washington State

2. Objectives Describe how to simplify and even eliminate forms for cohort review Provide more interactive learning during the cohort review Personalize data so it’s more relevant to local health department staff

3. Cohort Review CDC The cohort review is a very useful tool for ensuring accountability, informing and educating program staff about protocol and national objectives, and improving case management and prevention. To improve TB case management and program accountability and feedback, the grantees shall conduct at least one cohort review per year at the state or local levels or both. Programs should continue with ongoing case reviews as usual. Cohort Reviews should be implemented based on the guidance provided by the CDC Division of Tuberculosis Elimination (http://www.cdc.gov/tb/publications/guidestoolkits/ cohort/letter.htm).

4. Cohort Review 2003- 2011 2003 – Cohort Review implemented statewide (based on the NYC model) 2010 – Cohort Review became a requirement of CDC Late 2010 – A workgroup was formed to revise and develop an improved case management and cohort review process

5. Old CR model 2003 – Cohort Review implemented – All day quarterly retrospective review of all cases from pre-determined time frames (9 months to 1 year before) – Mock cohort – LHJs called in or attended in-person – Epi-presentation of past data

7. Perspectives Retrospective, unable to intervene and implement recommendations Scripted and hard to follow, especially via phone Too long to be on the phone listening to scripted case reports

8. Workgroup Consisted of: – Local Health Jurisdiction (LHJ) TB staff – Medical Consultant – DOH TB Program staff – DOH State Epidemiologists

9. Workgroup, cont. Ideas proposed by the workgroup were: – To review cases in real-time – clinical case management oversight; – Eliminate the cohort review presentation forms – capture all necessary data in Public Health Issue Management System (PHIMS) TB; – Change quarterly format from retrospective case presentations to clinical review of current cases; – Incorporate biannual program evaluation (based on core objectives and measures) with a cohort review of selected cases – Make process more effective, efficient, and interactive

10. New Format Outline Two part process: 1) Quarterly case review – QA process by DOH TB staff 2) Biannual indicator review and cohort review – Presentation of core indicators and interactive case studies

11. New Format Outline, Part 1

12. New Format Outline, Part 2

13. New Form

14. Core Indicators Cases who complete treatment in 12 months Sputum culture conversion Time from sputum smear positive result to starting TB treatment Treatment failures and relapse rates Contacts evaluated Contacts who start/complete treatment for LTBI

15. Timeline

16. Expectations LHJ: – Keep PHIMS TB data current and accurate – Timely follow-up on issues from case reviews (ex. missing PHIMS data) DOH: – Monitor core indicators – Provide and assist LHJs with follow-up tasks – Offer feedback from medical expert

17. Revisions No forms - no longer reading a script! Real-time review of current cases Designated time slots=more efficient use of LHJ time Cases may be reviewed multiple times before closure in PHIMS TB Interactive learning through selected cases DOH provides indicator data for ALL of WA State Indicator data will also be provided for individual LHJs

18. Survey Results Our preliminary results from the spring meeting shows on question #3 I learned helpful strategies in handling my TB cases from the cohort review and will make changes based on things I learned went from 40% saying they agreed for the old model to 90% saying they agreed when attending the new model of the Cohort Review. November 2012 results to follow.

19. Perspectives “ I had stopped attending cohort review because it had become so cursory, as to not afford a good learning opportunity for me. The 2012 cohort review was a great learning experience and I look forward to next ones. Hearing the discussion of different settings and scenarios, challenges, and how different people handle situations was fascinating. There was a richness of information shared, wrap up of lessons learned and ideas for going forward to handle problems identified that made it well worth my time and rich learning experiences!” “I just wanted to thank you (and your team) for changing the format of the Cohort review. I appreciated hearing about the other cases and thought the discussions were excellent.” “I love the new format for the biannual cohort review. It was much more interactive, interesting and beneficial to have the open discussion at the end of the case presentations. I am so glad we are not just reading down a list of dates of this and that.” “I appreciate the insight to the cases and comments from LHJ/state/medical staff. It seemed like more of a learning opportunity than just a presentation of a case. I like this format better. “

20. Future Continue enhancements to collect complete data in PHIMS TB Ongoing evaluation by LHJ TB Program staff Proposed annual meeting of the workgroup

21. Other experiences

22. Questions

23. Contact Information Sheanne Allen TB Controller/Program Manager Washington State Dept of Health Ph: 360-236-3423 sheanne.allen@doh.wa.gov Sherry Carlson TB Education Consultant Washington State Dept of Health Ph: 360-236-3528 sherry.carlson@doh.wa.gov