The 130th Annual Meeting of APHA

Abstract #49311

Tambi Shaw, Anne Cass, MPH, Melissa Ehman, MPH, Jan Young, RN, MS, Jennifer Flood, MD, MPH, and Sarah Royce, MD, MPH. Tuberculosis Control Branch, California Department of Health Services, 2151 Berkeley Way, Room 608, Berkeley, CA 94704, 510-540-3209, tshaw@dhs.ca.gov

Introduction: The Institute of Medicine’s recent report Ending Neglect: The Elimination of Tuberculosis in the United States recommends, “New program standards be developed and used by CDC and state and local health departments to evaluate program performance.” The California Department of Health Services’ (CDHS) Tuberculosis (TB) Indicators Project (TIP) uses a systematic approach to improve program performance.

Methods: Nineteen local health departments (LHDs) that contribute 93% of California’s TB morbidity participate in TIP. CDHS distributes annual LHD-specific reports showing performance on 17 indicators. The indicators measure patient outcomes and program adherence to TB standards. LHD and state staff use the indicator data to engage in a collaborative program improvement process.

Results: Eleven LHDs are developing or have completed action plans based on the indicators. Three LHDs plan to improve timely reporting; two LHDs plan to increase the proportion of patients receiving appropriate initial treatment; six LHDs plan to improve performance in documenting culture conversion; four LHDs have decided to focus efforts on ensuring high-risk TB patients receive directly observed therapy; three LHDs plan to increase the proportion of TB patients who complete therapy. Interventions are primarily aimed at improving LHD ability to detect and correct deviations from standards of patient and public health care. CDC’s preliminary evaluation of TIP suggests that it is well received by participants and has benefits at the state and local levels

Conclusions: TIP is a replicable model that can strengthen the ability of TB control programs to implement core public health functions.

Learning Objectives: At the conclusion of the session, the participant will be able to

• describe four purposes of TB program evaluation;
• define five indicators that link TB surveillance data to established standards of TB care and desirable public health and patient outcomes;
• articulate a method for identifying, investigating, and impacting major contributing factors to suboptimal performance; and
• describe four limitations of TB indicators.

Keywords: Tuberculosis, Performance Measurement

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.