Evaluation of Sputum Culture Conversion Journey of a New TB PEN Focal Point Debbie Staley, RN, BSN, MPH Virginia Department of Health Division of Disease Prevention TB Control Program TB PEN Conference, September 21, 2011
Sputum Conversion –Evaluation Plan Development • Topic of evaluation determined in the “Program Evaluation Framework, 2010 for Virginia Department of Health, Division of Disease Prevention, TB Control and Prevention Program” • Assessed two indicators in 2010 • Sputa collection if respiratory site of disease • Documented sputum conversion if sputa culture positive
Rationale for Evaluation Focus • Sputum culture conversion with weakest performance in 2008, at 42.2% • Evaluation of sputum culture conversion is dependent on sputum collection for those with respiratory site of disease.
Evaluation Objectives • Improve the percentage of patients who culture convert within 60 days of treatment initiation • Describe the differences between those who convert and those who did not convert • Determine if results are available but not reported or if specimens were not collected • Develop strategies for improvement in areas where impact is possible
Journey of a New TB PEN Focal Point • September 2010- TB Focal Point responsibilities began • Cohort Review conducted at central program level for 2009 • Attended cohort review webinar and on-site training, November 2010 • Informed of the need to conduct a focused evaluation of sputum collection and conversion
Evaluation of 6 Indices for all 2009 TB Cases • Completed internal central office cohort review • Collated data using Excel spreadsheet • 271 TB cases reported in 2009 • 225 with respiratory site of disease • 92.9% with sputa collected • 140 sputa culture positive • Sputum culture conversion 59.1%
Virginia Department of Health • 35 Health Districts • 2 Districts not organizationally part of VDH • 1 Of these Districts with 31.7% of 2009 Virginia morbidity AND use their own lab • This district the focus of sputa conversion investigation
Evaluation Activities • Phone calls and faxes to district of major morbidity • Sputum conversion outcomes • Sputa was collected in all but two cases, of 8 • Sputa not collected (1) • Client unable to produce sputa with induction (1)
Outcomes • Failure to convert due to • Extensive disease • Inadequate serum drug levels • Drug resistance • Failure to collect sputa in a timely manner • Patient unable to cough with induction • Staff turnover/vacancies • Improvement in sputum conversion from to 59.1% with only intervention education re: upcoming cohort review plans
The ‘Ah-ha” Moment: Cohort vs. RVCT • Cohort definition: “The proportion of TB patients with positive sputum culture results who have documented conversion to sputum culture negative within 60 days of treatment initiation.” Data Sources: RVCT fields: “…sputum culture, date therapy started, date therapy stopped, reason therapy stopped, sputum culture conversion documented” and Calculation: “number of TB patients with positive sputum culture results who have documented conversion to sputum culture-negative within 60 days of treatment initiation.
RVCT Definition • RVCT definition (a.k.a. NTIP definition) “Complete only for patients who had 1 or more positive sputum cultures and who subsequently had at least 1 documented negative culture.This date should be at least 1 week after the last positive culture result. There should be no positive cultures after this date.