Using program evaluation to improve inter-jurisdictional practices for TB case management

The core principles of quality management and performance improvement are deeply ingrained in health care organizations faced with increasing need to show value-adding work that meets or exceeds stakeholder expectations for continuous quality improvement (CQI). Efforts to introduce and sustain the use of quality improvement methods in public health organizations have been far more challenging. This exploratory study examined agency-specific practices and processes currently being used to manage the treatment and follow-up of tuberculosis (TB) cases in five county health departments in southeast Michigan and the city of Detroit, where 75% of TB cases are reported. Guidelines published by the Michigan Advisory Committee for Elimination of TB [MIACET] outline specific practices designed to treat and manage patients with active and latent TB infection, and conduct contact investigation; yet there has been increasing evidence of inter-jurisdictional variation in practices, resulting in under-treatment and inadequate follow-up of cases and contacts. Through this comprehensive program evaluation, the degree and potential causes of inter-jurisdictional variation in practice, including environmental factors that promote or inhibit work processes, were examined. The results from this evaluation will inform key stakeholders of current practices and challenges in the management of TB cases, contribute to a better understanding of potential barriers to protocol compliance, identify opportunities to strengthen and standardize inter-jurisdictional case management practices, and allow decision-makers to identify and prioritize effective intervention strategies at the state and local level. This poster presentation will discuss key findings from this program evaluation and recommend an evidence-based approach to address individual and inter-jurisdictional practice variation in TB case management.