TB NETWORK

Developing a cohort review process for Greater Manchester

Cohort reviews provide a systematic way of looking at the management of TB patients and their contacts and has proven to be a very useful tool for ensuring accountability, educational learning and improving case management and prevention.

Local services may already review TB cases and contacts yet the cohort review method builds on this practice but adds a systematic approach that leads to a quantitative difference to program evaluation and examination of treatment outcomes.

It is a management process that will motivate staff, reveal programme strengths and weaknesses, indicate staff training and professional education needs, increase staff accountability for completion of treatment for both TB disease and latent TB infection (LTBI), and improve TB case management and the identification of contacts.

The cohort review process can take many forms but in its simplest format, TB staff meet to review the treatment outcomes of every patient listed in a chronological patient register. A 'cohort' is a group of TB cases counted over a specific period of time and the cases are reviewed approximately six to nine months after they are counted; therefore many of the patients have either completed, or nearing the end of treatment.

Details regarding the management and outcomes of TB cases are reviewed in a group setting with case details presented by the case manager. These details may include:

  • Patient’s clinical status
  • Patient’s treatment outcome
  • Adequacy of the medication regimen
  • Treatment adherence or completion
  • Results of contact investigation
  • Percentage of patients who did, or are likely to, complete treatment.

In addition case clustering can be assessed with data on TB germ genetic footprints provided by the Health Protection Agency. The presentation of cases allows staff to detect potential problems in the way the case is being managed and allows clinicians, managers, and public health advisors to consult on difficult cases, as well as enabling senior staff and managers to recognise the intensive efforts involved in managing TB cases and contacts.

Introducing a programme of cohort reviews will be a challenging undertaking and the positive results may not be immediately evident but some excellent work originally undertaken in New York, and more recently adopted in London, has witnessed some very positive results and there is a firm commitment and intention to develop the programme across Greater Manchester, with further news on progress to follow shortly.