Tuberculosis Rate Improvement Project
Tuberculosis is difficult to eradicate, it can have devastating health impacts, and one active TB case can result in budget-breaking expenses for small-to-medium local health jurisdictions. A local health department in Washington state implemented a quality planning and quality improvement project to increase the percentage of high-risk clients with latent TB infection (LTBI) who are seen by staff and start treatment through two interventions: (1) reducing the time staff spent with low-risk LTBI clients; (2) improving one-to-one communication and follow-up with high risk LTBI clients.
Whatcom County Health Department's (WCHD's) initial quality improvement (QI) aim statement was as follows: “By July 1, 2013, the TB program will increase the percentage of high-risk clients with latent tuberculosis infection (LTBI) who start treatment by 5%.” This aim statement was revised to read, “By July 31, 2013, the TB program will increase the percentage of high-risk clients with LTBI who start treatment by 5%." As the project progressed, the team realized the layers of complexity in the TB program, which resulted in an additional focus on quality planning. The following aim statement was developed: “By July 31, 2013, the TB program will increase the percentage of high-risk clients with LTBI who are seen by WCHD staff from 75% to 90%. This goal will be accomplished by decreasing the number of low-risk clients with LTBI who are seen by WCHD staff.” To move forward on this goal, the team researched TB programs in several health departments; all had screening criteria. Because WCHD lacked criteria, the team concluded that screening guidelines should be developed that limit clients seen to those at high risk for active TB. The root cause of the problem was spending too much time on screening low-risk referrals. The team drafted LTBI screening guidelines and a timeline. Instituting the screening guidelines is ongoing and scheduled for completion by December 2013. The team then focused on the QI effort. The team identified the root cause of clients not starting treatment as a lack of one-to-one contact with staff. Identifying the problem resulted in improving communication and follow-up with clients. The team also realized that TB client data collection was inaccurate and not automated. An improved data collection system will be an ongoing focus.
Organization that conducted the QI initiative:
Simmons, A. Public Health Quality Improvement Exchange. Tuberculosis Rate Improvement Project. Tue, 05/26/2015 - 08:17. Available at https://phqix.org/content/tuberculosis-rate-improvement-project. Accessed March 1, 2024.
Background and Aim
Planning and Execution Details
Training and Preparation
Information about the Community
Information about the Health Department
QI Staff Information
Contact Information of the Submitter
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