Using surveillance data to guide patient care: Lessons learned from integrating the National TB Indicators Project into Cohort Review

Cohort review is a systematic review of patients with tuberculosis (TB) disease and their contacts. A cohort of patients is reviewed on a quarterly basis, with a case-by-case presentation. In 2009, a pilot program was undertaken in collaboration with the Centers for Disease Control and Prevention to incorporate program performance data into the cohort summary using indicators provided by the National TB indicators (NTIP).The pilot was intended to conduct both process and outcome evaluation to assess whether cases were meeting targets, to gain a better understanding when indicators were not met, and to mobilize efforts for improvement in patient care and programmatic function. For the second half of 2009, when pilot implementation took place, 5 of 10 (50%) indicators were met on a program-wide basis. When every TB patient was assessed in terms of meeting one of ten core indicators, 60 of 73 cases (82%) met at least 80% of eligible indicators. On average, patients met 91% of indicators. When indicators were not met, discussion focused on barriers and potential solutions. Feedback was also provided when a patient was handled particularly well. The pilot process has helped to connect case discussions with performance summary reports, and allowed the TB program to focus on larger program evaluation issues, as well as engaging a wider diversity of stakeholders and staff. These results demonstrate that the combined cohort review and NTIP process has the potential to be an effective tool in improving outcomes for TB control.