1 TB Contact and Investigation and Management TB Disease Management TB Disease Identification LTBI Management
WRHA Program: Tuberculosis Management Pillars of Excellence (What we are measuring)
Levels of Accountability (Who uses the KPI
for making decisions/ recommendations)
Customer Satisfaction Quality and Outcomes Delivery and Utilization Resource Management Employee Engagement Level 3: Oversight – Directors, Medical Directors, VP’s ITBS005 ITBS003 ITBS004 ITBS006 Level 2: Management Committee includes Chairs of each of the 4 Spectrum
Committees Level 1:
4 Spectrum Committees with membership from program delivery ITBS002 ITBS007 ITBS011 ITBS012 ITBS001 ITBS008 ITBS009 ITBS010 ITBS013 Definitions/Acronyms:
ITBS – Integrated TB Services – structural name for all organizational entities involved in all things TB related (logical umbrella)
LTBI – Latent TB Infection – tested positive but symptom dormant TB - Tuberculosis
PCR – Preliminary Chain Reaction – DNA technology AFB – Acid Fast Bacilli
ICD – International Classification of Diseases HIM – Health Information Management iPHIS – Population Health Information System
Note: “views” of a KPI may be different where it maps to more than one cell; the KPI can be customized to the audience in each level and/or dimension
Levels of accountability notation: for these KPI’s a primary level of accountability has been identified with secondary accountability levels shown in square brackets example:
Level 1 [2, 3]
2 investigation and management Utilization Level 1 [2-3] Rationale: operational indication of program delivery
Issue of access and identification (tracking) and continuity of service
follow-up not complete within a Contact
Investigation
contacts from the list identified in the denominator that as of 3-months later who are not yet completed assessment for infection/disease
unique contacts associated with all cases in a 1-month period that received a sputum PCR or culture confirmed diagnosis of respiratory TB in that month Registry iPHIS TB Contact investigation and management Quality and Outcomes Level 1 [2-3] Rationale: operational indication of program delivery
ITBS002 2. A measure of program functioning
Safety and efficacy
The proportion of newly diagnosed laboratory-confirmed or clinical-confirmed TB disease within a Contact Investigation Number of unique contacts from the list identified in the denominator that as of 3-months later are either a laboratory-confirmed or clinical-confirmed case of TB disease Total number of unique contacts associated with all cases in a 1-month period that received a sputum PCR or culture confirmed diagnosis of respiratory TB in that month
3 Spectrum
Group
Matrix Cells ID RATIONAL INDICATOR NUMERATOR DENOMINATOR DATA SOURCE
TB Contact investigation and management Resource Management Level 3 [1, 2] Rationale: senior leaders are aware of sustainability of program
resources
ITBS003 3. A measure of program functioning
Overlaps with Quality & Outcomes (Detection)
But is focused on resourcing the population identification (i.e. LTBI reservoir is huge in northern regions) Focus on what needs to happen.
The proportion of newly identified latent TB infection within a Contact Investigation
Number of unique contacts from the list identified in the denominator that as of 3-months later were newly diagnosed with latent TB Total number of unique contacts associated with all cases in a 1-month period that received a sputum PCR or culture confirmed diagnosis of respiratory TB in that month TB Contact investigation and management Resource Management Levels 3 [1, 2] Rationale: senior leaders are aware of sustainability of program
resources
ITBS004 4. A measure of program functioning The proportion of contacts with no evidence of TB disease or latent TB infection within a Contact Investigation Number of unique contacts from the list identified in the denominator that as of 3-months later were found to have no evidence of TB disease or
Total number of unique contacts associated with all cases in a 1-month period that received a sputum PCR or culture confirmed diagnosis of respiratory TB in that month
4 Management Outcomes
Level 3 [2, 1] “Closing the loop” Levels 1 and 2 are confident that Level 3 is aware of the problem and is discussing it at a senior level Rationale: cross- sector senior leaders aware of inadequate community resources
Front line staff [Level 1] (nurses/ physicians) are reporting these patients presenting to acute.
admitted persons diagnosed with TB disease, admitted to hospital despite being assessed as clinically well enough to receive their TB care as an outpatient (i.e., unable to provide adequate isolation in a community “home like” setting). persons diagnosed with TB disease, admitted to a Winnipeg Health Region hospital despite being assessed as clinically well enough to receive their TB care as an outpatient (i.e., unable to provide adequate isolation in a community “home like” setting). persons annually diagnosed with TB disease, who are admitted to a Winnipeg Health Region hospital. Registry Manitoba Health HIM (Health Information Management)
5 Spectrum
Group
Matrix Cells ID RATIONAL INDICATOR NUMERATOR DENOMINATOR DATA SOURCE
TB Disease Management Resource Management Level 3 [1, 2] Rationale: cross- sector senior leaders aware of inadequate community resources and the pressure it puts on acute care
ITBS006 2. To estimate the number of bed days utilized from inappropriate admissions
Average number of days of
hospitalization of persons diagnosed with TB disease who are identified as clinically well enough to receive their TB care as an outpatient (i.e., unable to provide adequate isolation in a community “home like” setting).
Total annual number of days spent in a Winnipeg hospital for all admitted persons diagnosed with TB disease who are admitted to a Winnipeg Health Region hospital and are identified as clinically well enough to receive their TB care as an outpatient at the time of
admission.
Total annual number of admitted persons diagnosed with TB disease, admitted to a Winnipeg Health Region hospital despite being assessed as clinically well enough to receive their TB care as an outpatient.
6 TB Disease Management Quality & Outcomes Level 1 [2, 3] Rationale: operational level measure of effectiveness of support of chronic disease management
ITBS007 3. A measure of treatment completion. defined as at least 80% of total doses completed within 9 months for persons prescribed a 6-month course of treatment, and within 12 months for persons prescribed a 9-month course of treatment
Proportion of persons diagnosed with TB disease and prescribed treatment by a Winnipeg Health Care Provider who start treatment for TB disease and who complete the prescribed course of TB treatment within 3 months of their targeted treatment completion date Annual number of persons diagnosed with TB disease who have been prescribed treatment by a Winnipeg Health Care Provider and who have started treatment, who complete a full course of treatment within 3 months of their targeted treatment completion date
Total annual number of persons
diagnosed with TB disease who have been prescribed treatment by a Winnipeg Health Care Provider and who have started treatment.
7 Spectrum
Group
Matrix Cells ID RATIONAL INDICATOR NUMERATOR DENOMINATOR DATA SOURCE
TB Disease Identification Delivery & Utilization Level 1 [2, 3] Rationale: operational measure of timeliness in primary care
ITBS008 1. To determine if there is a delay in diagnosis of TB and opportunity for health care provider education Start coughing date to 1st visit date
Time from Patient Identified Date of Onset of Cough Until First Visit to
Healthcare Provider for Respiratory Reason in all Persons with Culture
Confirmed Respiratory TB
Total time in days for all patients with culture confirmed respiratory TB measured from the patient identified date of onset of cough until the patient’s first visit to a healthcare provider for a respiratory related ICD9 reason code.
Total number of patients with culture confirmed respiratory TB. iPHIS Manitoba Health HIM (Health Information Management) TB Disease Identification Delivery & Utilization Level 1 [2, 3] Rationale: operational measure of effectiveness of primary care
ITBS009 2. To determine if there is a gap in health care knowledge of TB 1st Visit date to TB test date
Time from First Visit to Healthcare Provider for
Respiratory Reason Until Collection Date of First Sputum for AFB in all Persons with Culture Confirmed Respiratory TB
Total time in days for all patients with culture confirmed respiratory TB measured from the first visit to a healthcare provider for a respiratory related ICD9 reason code until the date of first sputum for AFB.
Total number of patients with culture confirmed
8 Identification Utilization Level 1 [2, 3] Rationale: operational measure of capacity requirements provider education
Healthcare Visits for Respiratory Reason Between the First Visit For Respiratory Reason and the Collection Date of First Sputum for AFB in all Persons with Culture Confirmed Respiratory TB
healthcare visits for a respiratory related ICD9 reason code for all patients with culture confirmed respiratory TB between the
patient’s first visit to a healthcare provider for a respiratory related ICD9 reason code and the date of first sputum for AFB.
patients with culture confirmed respiratory TB. LTBI Management Quality & Outcomes Level 1 [2, 3] Rationale: operational measure of capacity requirements
ITBS011 1. Determine what the baseline
percentage is. Benchmark is 80%. Further exploration on reasons why benchmark is not met
Proportion of persons diagnosed with LTBI, who ARE identified as contacts of Sputum Culture Confirmed Tuberculosis Cases, who start treatment for LTBI.
Number of persons diagnosed with LTBI who start treatment
Total number of persons annually diagnosed with LTBI, who ARE identified as contacts of Sputum Culture Confirmed Tuberculosis Cases Klinic database
9 Spectrum
Group
Matrix Cells ID RATIONAL INDICATOR NUMERATOR DENOMINATOR DATA SOURCE
LTBI Management Quality & Outcomes Level 1 [2, 3] Rationale: operational measure of effectiveness of support of prevention and disease management
ITBS012 2. Determine baseline for program
and further explore reasons why benchmark is not met (bench mark 80% of total doses)
Proportion of persons who start treatment for LTBI, who ARE identified as contacts of Sputum Culture Confirmed Tuberculosis Cases, who complete a full course of treatment for LTBI (defined as at least 80% of total doses)
Number of persons with LTBI who have started treatment, who complete a full course of treatment (i.e., at least 80% of total prescribed doses) Total number of persons annually diagnosed with LTBI, who ARE identified as contacts of Sputum Culture Confirmed
Tuberculosis Cases, who have started treatment for LTBI (i.e., the numerator for Indicator #1)
10 LTBI Management Resource Management Level 1 [2, 3) Rationale: operational measure of effectiveness of support of prevention and disease management
ITBS013 3. To determine the relative value of
follow up in lower risk groups to better inform resource allocation and recommendations on best practice
Are resources wasted on lower risk groups not committed to completing full course of treatment?
Proportion of persons who start treatment for LTBI, who ARE NOT
identified as contacts of Tuberculosis Cases, who complete a full course of treatment for LTBI (defined as at least 80% of total doses)
Number of persons with LTBI who have started treatment (who ARE NOT identified as contacts of Tuberculosis Cases), who complete a full course of treatment (i.e., at least 80% of total prescribed doses) Total number of persons annually diagnosed with LTBI, who ARE NOT identified as contacts of
Tuberculosis Cases, who have started treatment for LTBI
