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TB Nurse Case ManagementSan Antonio, Texas

December 8 10 2009December 8-10, 2009

Quality Improvement in Nurse Case Management

Lynelle Phillips RN MPHLynelle Phillips RN MPH

December 10, 2009

Quality Improvement in

Nurse Case Management

Lynelle Phillips RN MPHLynelle Phillips RN MPHTB Nurse Case Management Course

Heartland National TB CenterDecember 10, 2009

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Outline• Identify methods of quality improvement in nurse case

management.P ti– Programmatic

• National TB Indicators Project (NTIP)

• Cohort review

• Program assessment

• After Action Reviews

– Nurse Case Management Quality Assurance• NCM case reviews

• NCM Goal Matrix (NTNC)NCM Goal Matrix (NTNC)

• Staffing Standards (NTNC)

• Advantages and Disadvantages

• Resources

Case Management• “Case Management

provides critical servicesCase Management Model

Client

provides critical services to help patients and their caregivers navigate, coordinate, and transition through a dynamic approach to better

CaseManager

Assessment

Planning

FacilitationCoordination

EvaluationEmpowerment

Collaboration Problem Solving

Communication

Advocacy

ppachieve their health care goals.”

• Case Management Society of America, 2009

Case Management Society of America. Standards of Practice for Case Management. Little Rock, AR: CMSA; 1995

Provider Public Health

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Case Management• “Case Management

provides critical servicesprovides critical services to help patients and their caregivers navigate, coordinate, and transition through a dynamic approach to better

Case Management ModelClient

Advocacyppachieve their health care goals.”

• Case Management Society of America, 2009

Case Management Society of America. Standards of Practice for Case Management. Little Rock, AR: CMSA; 1995

Provider Public Health

CaseManager

Assessment

Planning

FacilitationCoordination

EvaluationEmpowerment

Collaboration Problem Solving

Communication

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• “Tuberculosis is a unique disease. For t th di d hi i imost other disorders, achieving cure is

primarily the patient’s concern. With TB, the responsibility for cure rests with the health care professional and ultimately with society.”

» Lee B Reichman, MD

National Tuberculosis Indicators Project (NTIP)

• Discuss utilizing surveillance data to evaluate program progress towards meeting objectives

– Where does data come from?

– Evaluation stepsp

– Assessing progress towards meeting objectives

Ijaz K, Young K, (2008)

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What is the NTIP?

• Monitoring system– Track progress of US tuberculosis (TB) control– Track progress of US tuberculosis (TB) control

programs

• Provides progress reports to TB programs– Using data already reported to the CDC

• Helps prioritize:– Prevention and control activities (local and national)– Program evaluation


NTIP Rationale

• Program evaluation is essential to effectiveness of public health programseffectiveness of public health programs

• Limited resources available to TB programs

• NTIP makes efficient use of existing data to help prioritize program activities and evaluations


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National TB Program Objectives

• 15 high-priority categories, selected by the CDC Division of Tuberculosis EliminationCDC Division of Tuberculosis Elimination (DTBE) and TB program representatives in 2006

• TB programs funded through cooperative agreements expected to report onagreements expected to report on progress toward all 15 categories starting in 2010


http://www.nyc.gov/html/doh/downloads/pdf/tb/tb-indicators-project-kai-young.pdf

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http://www.cdc.gov/TB/Program_Evaluation/Indicators/default.htm


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INDICATOR YEAR CURRENT STATEWIDE NATIONAL MOYEAR OBJECTIVE OBJECTIVE DATA

*2004 dataGOAL: Ensure early identification and reporting of all persons with tuberculosis.TB Case Rate 2005 3.4 0.5 0.5 1.9Reported within 2 weeks diagnosis 2005 100% 85% 85% nap gGOAL: All TB patients complete treatmentRecommended Initial Therapy 2005 100% na na 92%HIV testing for 25-44 year olds 2005 100% 90% 75% 82%Culture Conversion 2005 100% na na 76%*Appropriate DOT 2005 100% na na 77%*Timely completion of therapy within 12 months 2005 88% 95% 90% 91%*GOAL: Prevent TB transmissionContact Identification 2005 100% 90% 90% 97%C t t E l ti 2005 92% 100% 95% 64%Contact Evaluation 2005 92% 100% 95% 64%Contact Treatment Initiation 2005 93% na na 79%Contact Treatment Completion 2005 84% 60% 85% 63%*GOAL: Reduce the occurance of sentinel events.Pediatric TB Cases 2005 0% na na 3%TB Deaths 2005 33% na na 12%

INDICATOR YEAR CURRENT STATEWIDE NATIONAL MOYEAR OBJECTIVE OBJECTIVE DATA

*2004 dataGOAL: Ensure early identification and reporting of all persons with tuberculosis.TB Case Rate 2005 3.4 0.5 0.5 1.9Reported within 2 weeks diagnosis 2005 100% 85% 85% naGOAL: All TB patients complete treatmentRecommended Initial Therapy 2005 100% na na 92%HIV testing for 25-44 year olds 2005 100% 90% 75% 82%Culture Conversion 2005 100% na na 76%*Appropriate DOT 2005 100% na na 77%*Timely completion of therapy within 12 months 2005 88% 95% 90% 91%*GOAL: Prevent TB transmissionContact Identification 2005 100% 90% 90% 97%Contact Evaluation 2005 92% 100% 95% 64%Contact Evaluation 2005 92% 100% 95% 64%Contact Treatment Initiation 2005 93% na na 79%Contact Treatment Completion 2005 84% 60% 85% 63%*GOAL: Reduce the occurance of sentinel events.Pediatric TB Cases 2005 0% na na 3%TB Deaths 2005 33% na na 12%

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INDICATOR YEAR CURRENT STATEWIDE NATIONAL MO

YEAR OBJECTIVE OBJECTIVE DATA

*provisional *2004 dataGOAL: Ensure early identification and reporting of all persons with tuberculosis.TB Case Rate 6.1 0.5 0.5 1.9Reported within 2 weeks diagnosis 100% 85% 85% naReported within 2 weeks diagnosis 100% 85% 85% naGOAL: All TB patients complete treatmentRecommended Initial Therapy 100% na na 92%HIV testing for 25-44 year olds 100% 90% 75% 82%Culture Conversion 67% na na 76%*Appropriate DOT 93% na na 77%*Timely completion of therapy within 12 months 100%* 95% 90% 91%*GOAL: Prevent TB transmissionContact Identification 93% 90% 90% 97%C t t E l ti 48% 100% 95% 64%Contact Evaluation 48% 100% 95% 64%Contact Treatment Initiation 100% na na 79%Contact Treatment Completion 60% 60% 85% 63%*GOAL: Reduce the occurance of sentinel events.Pediatric TB Cases 4% na na 3%TB Deaths 4% na na 12%

INDICATOR YEAR CURRENT STATEWIDE NATIONAL MO

YEAR OBJECTIVE OBJECTIVE DATA

*provisional *2004 dataGOAL: Ensure early identification and reporting of all persons with tuberculosis.TB Case Rate 6.1 0.5 0.5 1.9Reported within 2 weeks diagnosis 100% 85% 85% naReported within 2 weeks diagnosis 100% 85% 85% naGOAL: All TB patients complete treatmentRecommended Initial Therapy 100% na na 92%HIV testing for 25-44 year olds 100% 90% 75% 82%Culture Conversion 67% na na 76%*Appropriate DOT 93% na na 77%*Timely completion of therapy within 12 months 100%* 95% 90% 91%*GOAL: Prevent TB transmissionContact Identification 93% 90% 90% 97%C t t E l ti 48% 100% 95% 64%Contact Evaluation 48% 100% 95% 64%Contact Treatment Initiation 100% na na 79%Contact Treatment Completion 60% 60% 85% 63%*GOAL: Reduce the occurance of sentinel events.Pediatric TB Cases 4% na na 3%TB Deaths 4% na na 12%

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Potential problems?• Difficult/high acuity patients

– “..it will likely become more difficult to treat patients…because of their social situations and ptreatment will be more labor intensive..the complexity of investigations will increase” IOM (2000)

• Training need– “…key challenge will be to maintain competency..”

IOM (2000)

• Not enough staff– “ …develop strategies for ensuring that resources for

TB elimination are available, despite a diminishing and unpredictable demand for services. IOM (2000)

• Management issues

• Unmotivated/morale problem

Drilling down….

• Evaluation process– Cohort review

– Program Assessments

• Nurse case management quality assurance– Case management review– Case management review

– Goal Matrix evaluation

– Staffing Standards

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What is Cohort Review (1)

• Cohort review is a systematic review of patients with tuberculosis (TB) disease andpatients with tuberculosis (TB) disease and their contacts.

• A “cohort” is a group of TB cases identified over a specific period of time, usually 3 months.

• The cases are reviewed approximately 6 - 9 months after they are reported, so that many of the patients have completed or are nearing the end of treatment.

http://www.harlemtbcenter.org/cohort_review.htm


TB cases are reviewed in a group setting with g p gthe following information presented on each case by the case manager:

• Patient's demographic information• Patient’s status: clinical, lab, radiology• Drug regimen, adherence, completiong g , , p• Results of contact investigation


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• Individual outcomes are assessedIndividual outcomes are assessed

• Group outcomes are also assessed

– Indicators track progress toward national, state, and local program objectives.

– Everyone leaves the meeting knowing the results.


RolesTB Program

Manager

Medical Reviewer

Data Ana lyst

Supervisor

Case Manager

Outreach Staff

DOT Staff

Community Providers

TB Contro l Cohort Review Team Members

TB Contro l Support S taff and Community Providers

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Timeline1ST QUARTER

JAN FEB MAR

2ND QUARTER

APR MAY JUN

3RD QUARTER

JUL AUG SEP

4TH QUARTER

OCT NOV DEC

1ST QUARTER

JAN FEB MAR

2ND QUARTER

APR MAY JUN

• TB cases identified

• Treatment started

• Contact investigation initiated

• Ongoing treatment of patients with TB disease

• Contacts evaluated and started on treatment, as necessary

• TB disease treatment completed

• Infected contacts continue on treatment for LTBI

1st quarter contacts complete treatment

COHORT • Continue follow up on issues CO OREVIEW SESSION

• Begin follow up on issues identified

Co t ue o o up o ssuesidentified during cohort review session

• Treatment completion rate presented for contacts of cases from previous 1st quarter

Timeline1ST QUARTER

JAN FEB MAR

2ND QUARTER

APR MAY JUN

3RD QUARTER

JUL AUG SEP

4TH QUARTER

OCT NOV DEC

1ST QUARTER

JAN FEB MAR

2ND QUARTER

APR MAY JUN

• TB cases identified

• Treatment started

• Contact investigation initiated

• Ongoing treatment of patients with TB disease

• Contacts evaluated and started on treatment, as necessary

• TB disease treatment completed

• Infected contacts continue on treatment for LTBI

1st quarter contacts complete treatment

COHORT • Continue follow up on issues CO OREVIEW SESSION

• Begin follow up on issues identified

Co t ue o o up o ssuesidentified during cohort review session

• Treatment completion rate presented for contacts of cases from previous 1st quarter

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Essential Elements

Cohort Review ProcessPreparation Presentation Follow up


Essential Elements of the Cohort Review Process

What are you already doing?YES

NO

What may need to be enhanced in order to conduct a cohort review:

1. Preparation

Ensuring that TB program staff know TB program objectives

Delineate local and regional objectives for your program Communicate these objectives to all TB program staff

Using a comprehensive case management system

Ensure that case management protocols are clearly written, comprehensive and practical for staff to implement

Using a reliable TB registry Specify data elements that need to be collected to evaluate program objectives Ensure that staff update registry information regularly Use the registry to generate cohort lists for TB control team members

Carefully preparing cases for presentation

Use periodic case reviews to ensure that case and contact information needed for the cohort review is collected Consider adding practice sessions to hone case presentation skills Implement a standard presentation format to ensure consistent, concise and complete presentations

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2. Presentation

Present each case in detail to the TB control team

Allow team members sufficient time to analyze and evaluate TB cases and contact investigations

Providing on-the-spot feedback to staff, aggregate reporting, and troubleshooting

Allow time for troubleshooting of case management issues Develop a standard format for aggregate reporting of data

3. Follow up

Follo p of identified Team members use information gathered at cohort Follow up of identified problems

Team members use information gathered at cohort to follow up on cases/contact investigations, identify staff training issues, and solve programmatic problems

Cohort Review ProcessWhat is Evaluated?

• Current status of each patientCurrent status of each patient– Cured or current to care and likely to complete in 365 days– Died, moved, lost, refused treatment or unlikely to complete

treatment within 365 days– Directly Observed Treatment (DOT) status and compliance

to DOT– Review of contact or source case investigation

• Measurable resultsMeasurable results– Completion of treatment within 365 days– Contact index– Contact evaluation and outcome of those on treatment of

LTBI


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Cohort Review Process Goals

• Evaluate process of public health intervention to:intervention to:– ensure appropriate regimen used– ensure timely treatment completion– improve timeliness of interventions– shorten time between contact identification

and testingand testing– improve management of infected contacts– analyze outcome to develop appropriate

interventionshttp://www.harlemtbcenter.org/cohort_review.htm

Cohort Review Approach

• Most important meeting of TB program

L t h b d b h d• Low tech, can be done by hand

• Closely linked to CDC objectives

• Group process

• Every one leaves meeting knowing results

• Teaching opportunityg pp y

• Gives director feeling for current issues


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Cohort Review Process Strengths

• Informational and systematic– Director reviews every caseDirector reviews every case

• TB staff collaboration• Public accountability for case management and follow-up

of contacts• National objectives tracked• Can be modified to add/delete items as needed• Consistent with global principles of TB control• Consistent with global principles of TB control


Cohort Review Process Limitations

• Retrospective• Retrospective – Timeliness of some aspects of care cannot be assessed– May be too late to make interventions– Monday-morning quarterbacking dynamic

• Details of problems in case management cannot be addressed

• Several items we want to evaluate are not easily captured in TB Registry– e.g. Non adherent contacts, mental health issues

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Program Assessments

• Annual

• Typically for high morbidity areas

• Formal report process

• Assessment team

• Independent reviewers included on team– State advisory committee

TB Case Rates by Area 1991-2005cases per 100,000


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18 MissouriSt. Louis County

2

4

6

8

10

12

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16 St. Louis CountySt. Louis CityKansas CitySpfd/Grn

0

2

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

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Program Assessment Format

• Assessment tool

• Process– Jurisdiction prepares report

– In-person review between state/regional staff and jurisdiction

• Team of reviewers

– Reviewers prepare a report with recommendations

Sample of Program AssessmentIII. SURVEILLANCE (LTBI AND DISEASE)1.What is the number and percentage of new cases reported within 24 – 72 hours from time of suspected diagnosis or positive laboratory result obtained? , %

2. HIV and TB2. HIV and TBa) Number and percentage of patients co-infected with TB/HIV: , %(b)Number of patients age 25-44 offered testing for HIV:(c)Number of patients age 25-44who accepted testing for HIV: • Number of any age patient offered testing for HIV: • Number of any age patient who accepted testing for HIV: • What is your policy on HIV counseling:

3.This is what the state shows for your risk groups. Please verify.

4. How do you share surveillance data with local medical professionals and community leaders?

5. Number of TB cases reported by:i h i i•Private Physicians:

•Hospitals: •Laboratories: •Other (please name):

6. Number of TB cases provided nursing case management by the local TB program: 7. The DHSS TB Program performs preventable case/death analysis on all TB cases.8. The number of preventable cases for your area. # and %.

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Strengths/Limitations

• Strengths– Build rapport/mutual respect between state and local staffpp p– Therapeutic– Opportunity to problem solve – understand problems more

thoroughly• Say what needs to be said

– Learning experience

• Limitations– Formalo a– Potentially threatening– Labor intensive– Aggregate information only



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18 MissouriSt Louis County

2

4

6

8

10

12

14

16 St. Louis CountySt. Louis CityKansas CitySpfd/Grn

0

2

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

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Always look back!Lessons learned/After action reviews

Aggregated Report of Program Evaluation

• Analysis of outbreak investigation

Priority 1 Priority 2 Priority 3 Employees onlysought 94 50 196 65evaluated 58 62% 30 60% 54 28% 20 31%TST positive 24 50% 4 14% 16 32% 7 37% previous positive 10 2 4 1started treatment 25 74% 5 83% 11 55% 6 75%completed 10 40% 2 40% 2 18% 1 17%

moved 0 0 1 0 moved 0 0 1 0 lost 6 0 2 2 refused 0 1 0 0 still on 9 36% 2 40% 6 55% 3 50%

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One's Two's Three's Employees onlysought 94 50 196 65evaluated 58 62% 30 60% 54 28% 20 31%TST positive 24 50% 4 14% 16 32% 7 37% previous positive 10 2 4 1started treatment 25 74% 5 83% 11 55% 6 75%completed 10 40% 2 40% 2 18% 1 17%




One's Two's Three's Employees onlysought 94 50 196 65evaluated 58 62% 30 60% 54 28% 20 31%TST positive 24 50% 4 14% 16 32% 7 37% previous positive 10 2 4 1started treatment 25 74% 5 83% 11 55% 6 75%completed 10 40% 2 40% 2 18% 1 17%


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Lessons learned

• Reprioritized contacts b dbased on investigation results

• Abandoned field-search for contacts

• Emphasized active• Emphasized active surveillance at the jail.

Looking back – you’ll be glad you did!

• Regroup and document whatdocument what worked and what did not work– All participants

• Lessons learned -implement changeimplement change for the next investigation

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Case Management Evaluation

• Periodic / routine case management ti ith l lmeeting with local nurse case managers

• Snap shot of cases at the time of the meeting– Individual report of cases

• Real time problem solving of barriers to• Real-time problem solving of barriers to treatment or isolation adherence and contact investigation problems.

Assessment essentials

• Patient name or identifier/history

Cli i l• Clinical– TST

– CXR - improvement

– Bacteriology – smear/culture conversion

– Med regimen – appropriate/tolerated/adherence

B i t t t t/i l ti• Barriers to treatment/isolation

• Contacts – barriers to contact investigation

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Case Management Format

Name/Identifier and history

Follow-up

Actions:

TST/IGRA

CXR

Bacteriology

Meds

Contacts

Barriers

Case Management Model• Advantages

– Opportunity to build rapport with TB case managers– Real-time problem solvingReal time problem solving– Share information and expertise– Learning opportunity for both nurses and program

managers– Less threatening/informal

• Disadvantages– Does not provide view of cases in aggregatep gg g– Difficult to juggle busy schedules– Informal– Less peer pressure

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Performance Measures (Goal Matrix) and Tools

• Developed by nurse consultants

• Tested by record reviews in 12 LHJ in 8 states

Used to teach monitor and evaluate• Used to teach, monitor, and evaluate practice

Performance Measures and Tools

Help Us To -p• Compare case manager performance to

expected standard

• Witness and mentor performance

• Describe, implement, record, and evaluate measures

• Identify needs for procedure development

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Nursing Interventions (NIC)

1. Risk identification2. Health screening3. Culture brokerage 4. Sustenance support

1. Lack of health seeking behaviors2. Risk for infection3. Communication impairment4 Ineffective health maintenance

1. Health seeking behavior 2. Risk detection 3. Communication ability 4 Social support

Patient Diagnosis (NANDA)

Short-Term Patient Outcomes (NOC)

Social Behavioral Approach to Treatment Adherence: Patient-Centered Care

pp5. Infection control6. Mutual goal setting7. Patient contracting8. Emotional support9. Patient’s rights protection10.Teaching

- disease process - treatment regimen

11. Medication management12. Health policy monitoring13. Discharge planning14 P t ti f

4. Ineffective health maintenance 5. Ineffective protection 6. Decisional conflict: whether to

participate in treatment7. Defensive coping8. Fear (stigma)9. Powerlessness: perceived threat10. Knowledge deficit

- disease process- treatment regimen

11. Ineffective therapeutic regimenmanagement

12. Noncompliance13. Ineffective family therapeutic

regimen management 14 Adjustment impairment:

4. Social support5. Immune status6. Participation in health care decisions7. Coping8. Fear self-control9. Health beliefs: perceived ability to perform10. Knowledge of

- disease process- treatment regimen

11. Medication response12. Compliance13. Family participation

in professional care

14. Well-being15. Community risk control

14. Protection from infection/disease15. Surveillance

14. Adjustment impairment:treatment behavior

15. Ineffective community coping

Long-TermOutcomes

Gibson et al., 2002. Johnson et al., 2006

Core Interventions - NIC

• Risk identification • Patient’s rightsRisk identification

• Health screening

• Culture brokerage

• Sustenance support

• Infection control

• Mutual goal setting

Patient s rights protection

• Teaching

• Medication management

• Health policy monitoring

• Discharge plang g

• Patient contracting

• Emotional support

• Protection from disease

• Surveillance

Gibson et al, 2002

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Nursing Intervention: Mutual Goal Setting Identify and Prioritize Care Goals and Develop a Plan for Achieving Goals

Goal Attainment Level Definition

Unacceptable Performance (0) Substandard: Does NONE of standard measures

Inadequate Performance (1) Substandard: Does >1 but not all of standard measures

Expected or Standard Performance (2)

Standard: Does ALL of following: 1. Assess for presence of DOT indicators 2. Assess for potential treatment barriers 3. Select enablers and/or incentives with patient’s input 4. Develop written plan 5. Review and implements plan with patient6. Use standard time frame for testing, x-rays, clinic visits, DOT, and drug

supply pp y

Good Performance (3) Does standard plus >1 of following: 1. Occasionally review adherence barriers with patient 2. Review plan, enablers and/or incentives at least once

Outstanding Performance (4) Does ALL standard, good, and outstanding measures: Review adherence barriers with patient at each visit

Self Evaluation Tool for Case Manager

• Mark selected goal interventions

• Record performance score for each selected intervention

• Sum performance scores for selected interventionsinterventions

• Divide sum by number of selected interventions

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Mark the box when standard measure is found in program policy/procedure, recorded or not on clinical record form

Program Evaluation Tool for NCM

recorded or not on clinical record form, or is performed but not recorded.

Goal Standard MeasuresProgram Policy

(yes/no)Recorded(yes/no)

Performed Not

Recorded(yes/no)

1 Risk Identification

TB-related risk factors

Symptoms of active TB

Changes in risk

Risk reduction steps

Results

Additional information helpf l to clinic• Additional information helpful to clinic nurses

• Example – Preference for food vehicle used to mix with patient’s medication was noted in chart. This made DOT successful in the field AND in the clinic setting

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Summary (I)• Goal not being met was identified early

• Using the Matrix Tool an adherence barrier was gidentified - DOT was 75% when done at the clinic site

• Working with the child and the family the barrier was overcome and the food vehicle was changed resulting in DOT adherence of 95-100%

• The Matrix Tool allows for a proactive approach and early identification of case management problems

Summary (II)Systematic and thorough review of NCM

documentation for quality improvement.

Attempts to assess processes towards treatmentAttempts to assess processes towards treatment completion and contact evaluation and treatment.

Disadvantages -

R t ti• Retrospective

• Complex

• Relies heavily on documentation

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TB STAFFING STANDARDS• WAY OF DETERMINING THE NUMBER OF

STAFF REQUIRED TO DO THE WORK OF ASTAFF REQUIRED TO DO THE WORK OF A TB CONTROL PROGRAM

• QUANTITATIVE STATEMENT DERIVED BY:– Determining hours of nursing staff time available in

the coming month to do the workg– Scope of work to be done throughout the coming

month which includes utilization of an acuity system which identifies patients’ needs

High Acuity Patients

–Substance abuse

H l–Homelessness

–Contacts not adherent

–Not adherent case

–Non-acceptance of TB

–Medical mismanagement/provider g pissues

–Treatment with IV medication and no home health

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Exercise:

PATIENT ACUITY ASSESSMENT

FACTORS IN DETERMINING WORKLOAD

• Amount of available work hours per month • Scheduled time off per month • The number of planned visits per month based

on acuity• Collaboration time per month (Providers, other

members of multi disciplinary team)members of multi-disciplinary team)• Non-household worksite or institutional

investigations • Other time

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Results - KC• Kansas City

– Median 410 deficit hours or shortage 2 FTE– Issues

• Epidemiology specialists devoting hours to TB –actually paid out of bioterrorism $$$

• Nursing shortage– Results

• Added staff – prophy RN• New refugee nurse• Cooperative agreement – adding one FTE nurse

(.5 funded through cooperative agreement)

Staffing Standards

• AdvantagesProvides a meaningful assessment of time– Provides a meaningful assessment of time management and staff needs of a program

– Takes patient acuity into account

– Prospective method also facilitates management decisions.

• DisadvantagesDisadvantages– Complex

– Non-standard terminology/definitions

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You are not alone!

• National TB Nurse CoalitionT d i d h TB l ffi i l f– To advise and support the TB control officials of state, local, and territorial governments by providing, within NTCA, a coordinated nursing perspective on issues vital to the success of TB prevention and control programs.

– http://tbcontrollers.org/?page_id=4

• Division of TB Elimination – Nurse Consultant: Judy Gibson (404) 639-5322

[email protected] – join the listserve!

Heartland National TB Center

• Access

1 800 TEX LUNG (1 800 839 5864)– 1-800-TEX-LUNG (1-800-839-5864)

– Nurse Consultants: (210) 531-4546 or 4569

– Monday-Friday, 8:00 AM – 5:00 PM (CT)

– E-Mail

• Barbara Seaworth: [email protected]

• Catalina Navarro: [email protected]

• Debbie Onfore: [email protected]

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Quality Improvement• Its all about meeting objectives!

– NTIP

– Cohort Review

– Program Assessments

• NCM Quality Improvement– Case Reviews

– Performance Measures (Goal Matrix)

– Staffing Standards

References• Case Society of America Home Page, Available at: http://www.cmsa.org/default.aspx

Accessed 11-9-2009.• Case Management Adherence Guidelines (2006), Available at:

http://www.cmsa.org/portals/0/pdf/CMAG2.pdf Accessed 11-9-2009http://www.cmsa.org/portals/0/pdf/CMAG2.pdf Accessed 11 9 2009• Ijaz K, Young K, (2008) Program Evaluation: New Directions – Presentation, National

TB Controllers Association, June 11, 2008 Available at: https://www.signup4.net/public/ap.aspx?EID=2004179E&OID=110 Accessed 10-20-2008

• IOM (2000) Ending neglect: the elimination of TB in the United States. N. A. Press. Washington DC, Institute of Medicine (IOM).

• TB Cohort Review Process, Available at: http://www.harlemtbcenter.org/cohort_review.htm Accessed 10-13-2008

• Gibson J et al (2009) DTBE/FSEB Brown Bag Seminar Available at: htt // li ti / / d / i R di ID 3WNRF6 1 A d 11 6https://www.livemeeting.com/cc/cdc/view Recording ID: 3WNRF6-1 Accessed 11-6-2009.

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