Presentation on theme: "Evaluation of Sputum Culture Conversion"— Presentation transcript:
1 Evaluation of Sputum Culture Conversion Journey of a New TB PEN Focal PointDebbie Staley, RN, BSN, MPHVirginia Department of HealthDivision of Disease PreventionTB Control ProgramTB PEN Conference, September 21, 2011
2 Sputum Conversion – Evaluation Plan Development Topic of evaluation determined in the“Program Evaluation Framework, 2010 for Virginia Department of Health, Division of Disease Prevention, TB Control and Prevention Program”Assessed two indicators in 2010Sputa collection if respiratory site of diseaseDocumented sputum conversion if sputa culture positive
3 Rationale for Evaluation Focus Sputum culture conversion with weakest performance in 2008, at 42.2%Evaluation of sputum culture conversion is dependent on sputum collection for those with respiratory site of disease.
4 Evaluation Objectives Improve the percentage of patients who culture convert within 60 days of treatment initiationDescribe the differences between those who convert and those who did not convertDetermine if results are available but not reported or if specimens were not collectedDevelop strategies for improvement in areas where impact is possible
5 Journey of a New TB PEN Focal Point September TB Focal Point responsibilities beganCohort Review conducted at central program level for 2009Attended cohort review webinar and on-site training, November 2010Informed of the need to conduct a focused evaluation of sputum collection and conversion
6 Evaluation of 6 Indices for all 2009 TB Cases Completed internal central office cohort reviewCollated data using Excel spreadsheet271 TB cases reported in 2009225 with respiratory site of disease92.9% with sputa collected140 sputa culture positiveSputum culture conversion 59.1%
7 Virginia Department of Health 35 Health Districts2 Districts not organizationally part of VDH1 Of these Districts with 31.7% of Virginia morbidity AND use their own labThis district the focus of sputa conversion investigation
8 Evaluation Activities Phone calls and faxes to district of major morbiditySputum conversion outcomesSputa was collected in all but two cases, of 8Sputa not collected (1)Client unable to produce sputa with induction (1)
9 Outcomes Failure to convert due to Extensive diseaseInadequate serum drug levelsDrug resistanceFailure to collect sputa in a timely mannerPatient unable to cough with inductionStaff turnover/vacanciesImprovement in sputum conversion from to 59.1% with only intervention education re: upcoming cohort review plans
10 The ‘Ah-ha” Moment: Cohort vs. RVCT Cohort definition:“The proportion of TB patients with positive sputum culture results who have documented conversion to sputum culture negative within 60 days of treatment initiation.”Data Sources: RVCT fields: “…sputum culture, date therapy started, date therapy stopped, reason therapy stopped, sputum culture conversion documented” andCalculation: “number of TB patients with positive sputum culture results who have documented conversion to sputum culture-negative within 60 days of treatment initiation.
11 RVCT Definition RVCT definition (a.k.a. NTIP definition) “Complete only for patients who had 1 or more positive sputum cultures and who subsequently had at least 1 documented negative culture. This date should be at least 1 week after the last positive culture result. There should be no positive cultures after this date.