Tuberculosis Rate Improvement Project

Summary

Impact Statement: 
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.
Summary: 
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: 
WCHD
Citation: 

Simmons, A. Public Health Quality Improvement Exchange. Tuberculosis Rate Improvement Project. Tue, 05/26/2015 - 08:17. Available at https://www.phqix.org/content/tuberculosis-rate-improvement-project. Accessed February 25, 2018.

Submission Status: 
Completed
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Comments

Submitted by lkent on

This is a nice example of professionals coming together and using QI tools and processes to protect the community from a communicable disease that can be difficult to address. I look forward to reading your team's final results!

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Submitted by 4Sloan on

Thanks so much for recognizing the value of this project. We had wanted to undertake this for some time and once we got into it we were astounded by how many avenues there were to pursue: improving guidelines, improving client communication, improving data collection, storage, and reporting.

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Submitted by sharpjulie on

This is great! I've shared your project with our TB group here in my organization, as we are also dealing with a large population of individuals with LTBI. Don't be surprised if they reach out to you!

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Submitted by cgizzi on

Susan, Alice and team--You have done such a great job applying QI principles and tools to several program areas throughout your department! This is another nice example of the quality work you do in Whatcom County. I especially like how you include some ROI data (which I'm sure will be confirmed when you get your evaluation/outcomes data at the end of the year).

Cindan Gizzi
Tacoma-Pierce County Health Department
cgizzi@tpchd.org

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Submitted by 4Sloan on

Thanks so much, Cindan! I will be sure to pass your comment on to our team. Much appreciated and stay warm, Susan

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Submitted by 4Sloan on

Thanks everyone for all of your kind comments. The project is still moving forward and we look forward to sharing our results.

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Submitted by 4Sloan on

I just heard from our TB Supervisor that the project is complete once we have 4th Qtr. data for 2014. So, you can expect to see our results sometime in the first quarter of the new year. We are excited!

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Submitted by 4Sloan on

Our final project findings are now posted and we've had great results! So proud of our QI team and their perseverance through many obstacles.

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