Evaluation of Completion of Treatment for Tuberculosis in New York State Cheryl H. Kearns, MPH

Background/Timeline Summer 2004 Evaluation required as part of Cooperative Agreement Evaluation required as part of Cooperative Agreement Task Order 15: Enhancing TB Programs’ Capacity for Self-Evaluation: Testing New Tools and Developing an Evaluation Toolkit Task Order 15: Enhancing TB Programs’ Capacity for Self-Evaluation: Testing New Tools and Developing an Evaluation Toolkit

Background/Timeline Fall/Winter TO 15 – Guide to Developing an Evaluation Plan TO 15 – Guide to Developing an Evaluation Plan

Background/Timeline April 2005 New York State Evaluation Plan finalized Retrospective look at National Objective Performance for Retrospective look at National Objective Performance for Identify areas of strength and weakness Identify areas of strength and weakness Meet with counties Meet with counties

Completion of Treatment in New York State ( Exclusive of New York City ) Year # Eligible to Complete # Completing W/in 12 months Percent Completion Percent Completion Total1,6491,

Percent of Cases Who Complete Treatment within 12 Months by Morbidity * * Of those eligible to complete within 12 months. Source: New York State Department of Health Bureau of Tuberculosis Control

Percent of Cases Who Complete Treatment within 12 Months By County for those with Average >= 5 Cases, * * Of those eligible to complete within 12 months. Source: New York State Department of Health Bureau of Tuberculosis Control

Meet with Counties Present county performance graphs Present county performance graphs Encourage counties to evaluate performance Encourage counties to evaluate performance

Task Order 15 NYSDOH develops Chart Abstraction Tool NYSDOH develops Chart Abstraction Tool Hire local nurses familiar with record system Hire local nurses familiar with record system Project nurses gather data on Chart Abstraction Forms Project nurses gather data on Chart Abstraction Forms NYSDOH data entry, analysis NYSDOH data entry, analysis NYSDOH analysis to Counties / CDC / TBESC NYSDOH analysis to Counties / CDC / TBESC

Chart Abstraction Tool 109 Questions 109 Questions 20 sections 20 sections –Hospitalization –Airborne Isolation –Symptom review –Social needs –Language –Medical needs –Outreach Worker Information –Patient Education –Reporting and Documentation

Implementation Training and Pilot of Chart Abstraction tool Training and Pilot of Chart Abstraction tool –September 2005 Data Collection Data Collection –October 2005-April 2006 –Nassau (53 Cases) –Suffolk (61 Cases) Data Analysis Data Analysis –May 2006 – September 2006

Analysis 112 Charts were reviewed 112 Charts were reviewed 103 had COT info 103 had COT info 85 (82.5%) completed within 12 months 85 (82.5%) completed within 12 months 18 (17.5%) did not complete within 12 months 18 (17.5%) did not complete within 12 months

Reasons for Not Completing Prolonged culture positive Prolonged culture positive Rifampin Resistance Rifampin Resistance Pregnant and could not tolerate Rifampin Pregnant and could not tolerate Rifampin Comorbid conditions requiring extended regimen Comorbid conditions requiring extended regimen Died while on treatment Died while on treatment Moved Moved Vacation Vacation

Interventions 9 months on treatment 9 months on treatment National Objectives added to county contracts National Objectives added to county contracts Cohort review Cohort review