Understanding the TB Cohort Review Process: Instruction Guide
The purpose of this document is to describe the cohort review process.
The cohort review process has proven to be a very useful tool for
ensuring accountability, educating staff about protocols and objectives,
and improving case management and prevention. It is a management
process that will motivate staff, reveal programs’ strengths and
weaknesses, indicate staff training and professional education needs,
increase staff accountability for completion of treatment for both
TB disease and latent TB infection (LTBI), and improve TB case management
and the identification of contacts.
Cohort review is a systematic review of the management of patients
with TB disease and their contacts. A “cohort” is a group of TB
cases counted over a specific period of time, usually 3 months.
The cases are reviewed approximately 6–9 months after they are counted;
therefore, many of the patients have completed treatment or are
nearing the end of treatment. Details regarding the management
and outcomes of TB cases are reviewed in a group setting. Case managers
and other staff know that their day-to-day efforts will be reflected
in the cohort review several months later and that they are accountable
for the services they provide.
TB programs across the country have adopted a variety of approaches
to conducting cohort reviews. All of the approaches incorporate
the same key elements of preparation, presentation, and follow-up.
Preparation encompasses developing program objectives, ensuring
that sound case management protocols are in place, using a reliable
TB registry, and carefully preparing the case. The element of presentation
includes using a standardized format for cohort reviews, providing
TB case and contact information to the TB control team, and presenting
immediate feedback on goal accomplishment. Follow-up involves acting
on the recommendations made by the TB control team during the cohort
review session, ensuring that those patients and contacts started
on treatment complete treatment, and following up on programmatic
issues (e.g., training) that were noted at the cohort review session.
Using this process allows TB programs to improve outcomes through
a continual cycle of learning.
Adopting the cohort review methodology is a challenging undertaking.
As with any change in management approach, there will be bumps in
the road, and the positive results may not be immediately evident.
Successful implementation requires an ongoing commitment to adopting
this management approach, tailoring it to fit local needs, training
and motivating staff, and following up on noted problems.
“Cohort review can be an important means of increasing your completion
rate, of tracking your contact index, of seeing how well you are
doing with contact elicitation and starting contacts on treatment;
so every aspect of a TB program can be tracked through this. Basically
it is a management tool. It is a management tool that says we care
about every single patient…”
Thomas Frieden, MD, MPH, New York City Commissioner of Health
Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination - http://www.cdc.gov/tb
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CDC/Division of Tuberculosis Elimination
Communications, Education, and Behavioral Studies Branch
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