Journey of a New TB PEN Focal Point

Debbie Staley, RN, BSN, MPHVirginia Department of HealthDivision of Disease Prevention

TB Control ProgramTB PEN Conference, September 21, 2011

Evaluation of Sputum Culture Conversion

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 2010◦ Sputa collection if respiratory site of disease◦ Documented sputum conversion if sputa culture

positive

Sputum Conversion –Evaluation Plan Development

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.

Rationale for Evaluation Focus

Improve the percentage of patients who culture convert within 60 days of treatment initiation

Describe the differences between those who convert and those who did not convert

Determine if results are available but not reported or if specimens were not collected

Develop strategies for improvement in areas where impact is possible

Evaluation Objectives

September 2010- TB Focal Point responsibilities began

Cohort Review conducted at central program level for 2009

Attended cohort review webinar and on-site training, November 2010

Informed of the need to conduct a focused evaluation of sputum collection and conversion

Journey of a New TB PEN Focal Point

Completed internal central office cohort review

Collated data using Excel spreadsheet◦ 271 TB cases reported in 2009◦ 225 with respiratory site of disease

92.9% with sputa collected 140 sputa culture positive

◦ Sputum culture conversion 59.1%

Evaluation of 6 Indices for all 2009 TB Cases

35 Health Districts

2 Districts not organizationally part of VDH

1 Of these Districts with 31.7% of 2009 Virginia morbidity AND use their own lab

This district the focus of sputa conversion investigation

Virginia Department of Health

Phone calls and faxes to district of major morbidity

Sputum conversion outcomes◦ Sputa was collected in all but two cases, of 8

Sputa not collected (1) Client unable to produce sputa with induction (1)

Evaluation Activities

Failure to convert due to◦ Extensive disease◦ Inadequate serum drug levels ◦ Drug resistance

Failure to collect sputa in a timely manner◦ Patient unable to cough with induction◦ Staff turnover/vacancies

Improvement in sputum conversion from to 59.1% with only intervention education re: upcoming cohort review plans

Outcomes

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” and

Calculation: “number of TB patients with positive sputum culture results who have documented conversion to sputum culture-negative within 60 days of treatment initiation.

The ‘Ah-ha” Moment: Cohort vs. RVCT

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.

Discussion?

Questions?