Slide 1

Evaluation: LTBI Contact
Treatment in DC
Kim Seechuk, MPH
Bureau of TB Control
District of Columbia

DC’s Program Evaluation
 DC Quick Facts
 Plan Development
 Methods
 Results
 Lessons Learned

Washington DC Quick Facts
 61 Square Miles
 Eight Wards
 600,000 population
 50% Black
 13% Foreign born
 9% Hispanic
 59,000 median income
 18% below poverty

Number of Cases

District of Columbia TB Cases, 2000-2009
100
80
60
40
20
0

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

DC 85

74

82

79

81

55

Year

72

60

54

41

Evaluation Plan Development:
CDC Evaluation Framework

Step 1: Engage Stakeholders
 Conducted internal and external
stakeholder assessment
 Ultimately engaged internal stakeholders
only in evaluation planning

Program Objectives


Increase the proportion of contacts to
sputum AFB smear-positive TB patients
with newly diagnosed LTBI who start
treatment to 75%.



For above contacts who have started
treatment for LTBI, increase the
proportion of that complete treatment to
65%.

Step 2: Describe the Program
Baseline

 59 (32 sm+) cases in 2007
 90 LTBI contacts
 64 (71%) started treatment

 39 (61%) completed treatment
80
70
60
50
40

Baseline
Year

30
20
10
0
2006

2007

2008

2009

2010

Logic Model

Resources
 .5 FTE graduate intern x 6 months

 .1 FTE prevention specialist
 .1 FTE Program Manager
 Access to TB medical and program team

Step 3: Focus Evaluation Design
Evaluation Goals:
 Describe current processes for bringing
contacts with LTBI to treatment initiation and
completion;

 verify baseline findings;
 describe characteristics of contacts that
successfully begin and finish treatment;

 suggest changes to current process to
improved treatment initiation and completion.

Step 4: Gather Credible Evidence

Methods
Quantitative Review

− Program policies and protocols
− 2008 LTBI* medical/case management charts

 Observation of staff/patient interaction
− Physician, nurse case manager, TB investigator

 Qualitative Interviews
− patients who started and did/did not complete
treatment.
*number of LTBI contacts was very small, so expanded to all persons who
started LTBI treatment

Step 5: Justify Conclusions
Results

 Observations
 No actual written protocol for treatment offer
 Treatment offer was purview of the physician; no
 Consistent review of patient information sheet by
nurse on those who accepted

 Chart/Data Review – 2008 data
 33% (102/309) of LTBI patients completed therapy
 Black race and being foreign-born were associated
with not completing treatment
 History of incarceration was associated with
successfully completing treatment

Qualitative Interviews
 37 Patients contacted for interviews
 6 completed
 43% phone # wrong or disconnected
 30% never answered

Bust

Step 6: Ensure Use and Share
Lessons Learned
 Writing protocols-review & reinforce w/staff
 Determining steps to enhance treatment
offer beyond physician offer
 Language appropriate patient materials
 Considering:
 Increased case manager contact in first 2
weeks of starting treatment
 Pilot with community provider serving target
group (foreign born, black) to conduct LTBI
treatment follow up.

Lessons Learned (cont)
 High percentage of patients are transient
 Get multiple sources of locating information

 Check assumptions about what staff think is
happening

 Be realistic about what can be accomplished
 Assure data sources are easily accessed
 Assure evaluation is properly resourced

 Stay focused
 Avoid letting evaluation purpose drift or languish

Post Script


Slide 2

Evaluation: LTBI Contact
Treatment in DC
Kim Seechuk, MPH
Bureau of TB Control
District of Columbia

DC’s Program Evaluation
 DC Quick Facts
 Plan Development
 Methods
 Results
 Lessons Learned

Washington DC Quick Facts
 61 Square Miles
 Eight Wards
 600,000 population
 50% Black
 13% Foreign born
 9% Hispanic
 59,000 median income
 18% below poverty

Number of Cases

District of Columbia TB Cases, 2000-2009
100
80
60
40
20
0

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

DC 85

74

82

79

81

55

Year

72

60

54

41

Evaluation Plan Development:
CDC Evaluation Framework

Step 1: Engage Stakeholders
 Conducted internal and external
stakeholder assessment
 Ultimately engaged internal stakeholders
only in evaluation planning

Program Objectives


Increase the proportion of contacts to
sputum AFB smear-positive TB patients
with newly diagnosed LTBI who start
treatment to 75%.



For above contacts who have started
treatment for LTBI, increase the
proportion of that complete treatment to
65%.

Step 2: Describe the Program
Baseline

 59 (32 sm+) cases in 2007
 90 LTBI contacts
 64 (71%) started treatment

 39 (61%) completed treatment
80
70
60
50
40

Baseline
Year

30
20
10
0
2006

2007

2008

2009

2010

Logic Model

Resources
 .5 FTE graduate intern x 6 months

 .1 FTE prevention specialist
 .1 FTE Program Manager
 Access to TB medical and program team

Step 3: Focus Evaluation Design
Evaluation Goals:
 Describe current processes for bringing
contacts with LTBI to treatment initiation and
completion;

 verify baseline findings;
 describe characteristics of contacts that
successfully begin and finish treatment;

 suggest changes to current process to
improved treatment initiation and completion.

Step 4: Gather Credible Evidence

Methods
Quantitative Review

− Program policies and protocols
− 2008 LTBI* medical/case management charts

 Observation of staff/patient interaction
− Physician, nurse case manager, TB investigator

 Qualitative Interviews
− patients who started and did/did not complete
treatment.
*number of LTBI contacts was very small, so expanded to all persons who
started LTBI treatment

Step 5: Justify Conclusions
Results

 Observations
 No actual written protocol for treatment offer
 Treatment offer was purview of the physician; no
 Consistent review of patient information sheet by
nurse on those who accepted

 Chart/Data Review – 2008 data
 33% (102/309) of LTBI patients completed therapy
 Black race and being foreign-born were associated
with not completing treatment
 History of incarceration was associated with
successfully completing treatment

Qualitative Interviews
 37 Patients contacted for interviews
 6 completed
 43% phone # wrong or disconnected
 30% never answered

Bust

Step 6: Ensure Use and Share
Lessons Learned
 Writing protocols-review & reinforce w/staff
 Determining steps to enhance treatment
offer beyond physician offer
 Language appropriate patient materials
 Considering:
 Increased case manager contact in first 2
weeks of starting treatment
 Pilot with community provider serving target
group (foreign born, black) to conduct LTBI
treatment follow up.

Lessons Learned (cont)
 High percentage of patients are transient
 Get multiple sources of locating information

 Check assumptions about what staff think is
happening

 Be realistic about what can be accomplished
 Assure data sources are easily accessed
 Assure evaluation is properly resourced

 Stay focused
 Avoid letting evaluation purpose drift or languish

Post Script


Slide 3

Evaluation: LTBI Contact
Treatment in DC
Kim Seechuk, MPH
Bureau of TB Control
District of Columbia

DC’s Program Evaluation
 DC Quick Facts
 Plan Development
 Methods
 Results
 Lessons Learned

Washington DC Quick Facts
 61 Square Miles
 Eight Wards
 600,000 population
 50% Black
 13% Foreign born
 9% Hispanic
 59,000 median income
 18% below poverty

Number of Cases

District of Columbia TB Cases, 2000-2009
100
80
60
40
20
0

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

DC 85

74

82

79

81

55

Year

72

60

54

41

Evaluation Plan Development:
CDC Evaluation Framework

Step 1: Engage Stakeholders
 Conducted internal and external
stakeholder assessment
 Ultimately engaged internal stakeholders
only in evaluation planning

Program Objectives


Increase the proportion of contacts to
sputum AFB smear-positive TB patients
with newly diagnosed LTBI who start
treatment to 75%.



For above contacts who have started
treatment for LTBI, increase the
proportion of that complete treatment to
65%.

Step 2: Describe the Program
Baseline

 59 (32 sm+) cases in 2007
 90 LTBI contacts
 64 (71%) started treatment

 39 (61%) completed treatment
80
70
60
50
40

Baseline
Year

30
20
10
0
2006

2007

2008

2009

2010

Logic Model

Resources
 .5 FTE graduate intern x 6 months

 .1 FTE prevention specialist
 .1 FTE Program Manager
 Access to TB medical and program team

Step 3: Focus Evaluation Design
Evaluation Goals:
 Describe current processes for bringing
contacts with LTBI to treatment initiation and
completion;

 verify baseline findings;
 describe characteristics of contacts that
successfully begin and finish treatment;

 suggest changes to current process to
improved treatment initiation and completion.

Step 4: Gather Credible Evidence

Methods
Quantitative Review

− Program policies and protocols
− 2008 LTBI* medical/case management charts

 Observation of staff/patient interaction
− Physician, nurse case manager, TB investigator

 Qualitative Interviews
− patients who started and did/did not complete
treatment.
*number of LTBI contacts was very small, so expanded to all persons who
started LTBI treatment

Step 5: Justify Conclusions
Results

 Observations
 No actual written protocol for treatment offer
 Treatment offer was purview of the physician; no
 Consistent review of patient information sheet by
nurse on those who accepted

 Chart/Data Review – 2008 data
 33% (102/309) of LTBI patients completed therapy
 Black race and being foreign-born were associated
with not completing treatment
 History of incarceration was associated with
successfully completing treatment

Qualitative Interviews
 37 Patients contacted for interviews
 6 completed
 43% phone # wrong or disconnected
 30% never answered

Bust

Step 6: Ensure Use and Share
Lessons Learned
 Writing protocols-review & reinforce w/staff
 Determining steps to enhance treatment
offer beyond physician offer
 Language appropriate patient materials
 Considering:
 Increased case manager contact in first 2
weeks of starting treatment
 Pilot with community provider serving target
group (foreign born, black) to conduct LTBI
treatment follow up.

Lessons Learned (cont)
 High percentage of patients are transient
 Get multiple sources of locating information

 Check assumptions about what staff think is
happening

 Be realistic about what can be accomplished
 Assure data sources are easily accessed
 Assure evaluation is properly resourced

 Stay focused
 Avoid letting evaluation purpose drift or languish

Post Script


Slide 4

Evaluation: LTBI Contact
Treatment in DC
Kim Seechuk, MPH
Bureau of TB Control
District of Columbia

DC’s Program Evaluation
 DC Quick Facts
 Plan Development
 Methods
 Results
 Lessons Learned

Washington DC Quick Facts
 61 Square Miles
 Eight Wards
 600,000 population
 50% Black
 13% Foreign born
 9% Hispanic
 59,000 median income
 18% below poverty

Number of Cases

District of Columbia TB Cases, 2000-2009
100
80
60
40
20
0

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

DC 85

74

82

79

81

55

Year

72

60

54

41

Evaluation Plan Development:
CDC Evaluation Framework

Step 1: Engage Stakeholders
 Conducted internal and external
stakeholder assessment
 Ultimately engaged internal stakeholders
only in evaluation planning

Program Objectives


Increase the proportion of contacts to
sputum AFB smear-positive TB patients
with newly diagnosed LTBI who start
treatment to 75%.



For above contacts who have started
treatment for LTBI, increase the
proportion of that complete treatment to
65%.

Step 2: Describe the Program
Baseline

 59 (32 sm+) cases in 2007
 90 LTBI contacts
 64 (71%) started treatment

 39 (61%) completed treatment
80
70
60
50
40

Baseline
Year

30
20
10
0
2006

2007

2008

2009

2010

Logic Model

Resources
 .5 FTE graduate intern x 6 months

 .1 FTE prevention specialist
 .1 FTE Program Manager
 Access to TB medical and program team

Step 3: Focus Evaluation Design
Evaluation Goals:
 Describe current processes for bringing
contacts with LTBI to treatment initiation and
completion;

 verify baseline findings;
 describe characteristics of contacts that
successfully begin and finish treatment;

 suggest changes to current process to
improved treatment initiation and completion.

Step 4: Gather Credible Evidence

Methods
Quantitative Review

− Program policies and protocols
− 2008 LTBI* medical/case management charts

 Observation of staff/patient interaction
− Physician, nurse case manager, TB investigator

 Qualitative Interviews
− patients who started and did/did not complete
treatment.
*number of LTBI contacts was very small, so expanded to all persons who
started LTBI treatment

Step 5: Justify Conclusions
Results

 Observations
 No actual written protocol for treatment offer
 Treatment offer was purview of the physician; no
 Consistent review of patient information sheet by
nurse on those who accepted

 Chart/Data Review – 2008 data
 33% (102/309) of LTBI patients completed therapy
 Black race and being foreign-born were associated
with not completing treatment
 History of incarceration was associated with
successfully completing treatment

Qualitative Interviews
 37 Patients contacted for interviews
 6 completed
 43% phone # wrong or disconnected
 30% never answered

Bust

Step 6: Ensure Use and Share
Lessons Learned
 Writing protocols-review & reinforce w/staff
 Determining steps to enhance treatment
offer beyond physician offer
 Language appropriate patient materials
 Considering:
 Increased case manager contact in first 2
weeks of starting treatment
 Pilot with community provider serving target
group (foreign born, black) to conduct LTBI
treatment follow up.

Lessons Learned (cont)
 High percentage of patients are transient
 Get multiple sources of locating information

 Check assumptions about what staff think is
happening

 Be realistic about what can be accomplished
 Assure data sources are easily accessed
 Assure evaluation is properly resourced

 Stay focused
 Avoid letting evaluation purpose drift or languish

Post Script


Slide 5

Evaluation: LTBI Contact
Treatment in DC
Kim Seechuk, MPH
Bureau of TB Control
District of Columbia

DC’s Program Evaluation
 DC Quick Facts
 Plan Development
 Methods
 Results
 Lessons Learned

Washington DC Quick Facts
 61 Square Miles
 Eight Wards
 600,000 population
 50% Black
 13% Foreign born
 9% Hispanic
 59,000 median income
 18% below poverty

Number of Cases

District of Columbia TB Cases, 2000-2009
100
80
60
40
20
0

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

DC 85

74

82

79

81

55

Year

72

60

54

41

Evaluation Plan Development:
CDC Evaluation Framework

Step 1: Engage Stakeholders
 Conducted internal and external
stakeholder assessment
 Ultimately engaged internal stakeholders
only in evaluation planning

Program Objectives


Increase the proportion of contacts to
sputum AFB smear-positive TB patients
with newly diagnosed LTBI who start
treatment to 75%.



For above contacts who have started
treatment for LTBI, increase the
proportion of that complete treatment to
65%.

Step 2: Describe the Program
Baseline

 59 (32 sm+) cases in 2007
 90 LTBI contacts
 64 (71%) started treatment

 39 (61%) completed treatment
80
70
60
50
40

Baseline
Year

30
20
10
0
2006

2007

2008

2009

2010

Logic Model

Resources
 .5 FTE graduate intern x 6 months

 .1 FTE prevention specialist
 .1 FTE Program Manager
 Access to TB medical and program team

Step 3: Focus Evaluation Design
Evaluation Goals:
 Describe current processes for bringing
contacts with LTBI to treatment initiation and
completion;

 verify baseline findings;
 describe characteristics of contacts that
successfully begin and finish treatment;

 suggest changes to current process to
improved treatment initiation and completion.

Step 4: Gather Credible Evidence

Methods
Quantitative Review

− Program policies and protocols
− 2008 LTBI* medical/case management charts

 Observation of staff/patient interaction
− Physician, nurse case manager, TB investigator

 Qualitative Interviews
− patients who started and did/did not complete
treatment.
*number of LTBI contacts was very small, so expanded to all persons who
started LTBI treatment

Step 5: Justify Conclusions
Results

 Observations
 No actual written protocol for treatment offer
 Treatment offer was purview of the physician; no
 Consistent review of patient information sheet by
nurse on those who accepted

 Chart/Data Review – 2008 data
 33% (102/309) of LTBI patients completed therapy
 Black race and being foreign-born were associated
with not completing treatment
 History of incarceration was associated with
successfully completing treatment

Qualitative Interviews
 37 Patients contacted for interviews
 6 completed
 43% phone # wrong or disconnected
 30% never answered

Bust

Step 6: Ensure Use and Share
Lessons Learned
 Writing protocols-review & reinforce w/staff
 Determining steps to enhance treatment
offer beyond physician offer
 Language appropriate patient materials
 Considering:
 Increased case manager contact in first 2
weeks of starting treatment
 Pilot with community provider serving target
group (foreign born, black) to conduct LTBI
treatment follow up.

Lessons Learned (cont)
 High percentage of patients are transient
 Get multiple sources of locating information

 Check assumptions about what staff think is
happening

 Be realistic about what can be accomplished
 Assure data sources are easily accessed
 Assure evaluation is properly resourced

 Stay focused
 Avoid letting evaluation purpose drift or languish

Post Script


Slide 6

Evaluation: LTBI Contact
Treatment in DC
Kim Seechuk, MPH
Bureau of TB Control
District of Columbia

DC’s Program Evaluation
 DC Quick Facts
 Plan Development
 Methods
 Results
 Lessons Learned

Washington DC Quick Facts
 61 Square Miles
 Eight Wards
 600,000 population
 50% Black
 13% Foreign born
 9% Hispanic
 59,000 median income
 18% below poverty

Number of Cases

District of Columbia TB Cases, 2000-2009
100
80
60
40
20
0

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

DC 85

74

82

79

81

55

Year

72

60

54

41

Evaluation Plan Development:
CDC Evaluation Framework

Step 1: Engage Stakeholders
 Conducted internal and external
stakeholder assessment
 Ultimately engaged internal stakeholders
only in evaluation planning

Program Objectives


Increase the proportion of contacts to
sputum AFB smear-positive TB patients
with newly diagnosed LTBI who start
treatment to 75%.



For above contacts who have started
treatment for LTBI, increase the
proportion of that complete treatment to
65%.

Step 2: Describe the Program
Baseline

 59 (32 sm+) cases in 2007
 90 LTBI contacts
 64 (71%) started treatment

 39 (61%) completed treatment
80
70
60
50
40

Baseline
Year

30
20
10
0
2006

2007

2008

2009

2010

Logic Model

Resources
 .5 FTE graduate intern x 6 months

 .1 FTE prevention specialist
 .1 FTE Program Manager
 Access to TB medical and program team

Step 3: Focus Evaluation Design
Evaluation Goals:
 Describe current processes for bringing
contacts with LTBI to treatment initiation and
completion;

 verify baseline findings;
 describe characteristics of contacts that
successfully begin and finish treatment;

 suggest changes to current process to
improved treatment initiation and completion.

Step 4: Gather Credible Evidence

Methods
Quantitative Review

− Program policies and protocols
− 2008 LTBI* medical/case management charts

 Observation of staff/patient interaction
− Physician, nurse case manager, TB investigator

 Qualitative Interviews
− patients who started and did/did not complete
treatment.
*number of LTBI contacts was very small, so expanded to all persons who
started LTBI treatment

Step 5: Justify Conclusions
Results

 Observations
 No actual written protocol for treatment offer
 Treatment offer was purview of the physician; no
 Consistent review of patient information sheet by
nurse on those who accepted

 Chart/Data Review – 2008 data
 33% (102/309) of LTBI patients completed therapy
 Black race and being foreign-born were associated
with not completing treatment
 History of incarceration was associated with
successfully completing treatment

Qualitative Interviews
 37 Patients contacted for interviews
 6 completed
 43% phone # wrong or disconnected
 30% never answered

Bust

Step 6: Ensure Use and Share
Lessons Learned
 Writing protocols-review & reinforce w/staff
 Determining steps to enhance treatment
offer beyond physician offer
 Language appropriate patient materials
 Considering:
 Increased case manager contact in first 2
weeks of starting treatment
 Pilot with community provider serving target
group (foreign born, black) to conduct LTBI
treatment follow up.

Lessons Learned (cont)
 High percentage of patients are transient
 Get multiple sources of locating information

 Check assumptions about what staff think is
happening

 Be realistic about what can be accomplished
 Assure data sources are easily accessed
 Assure evaluation is properly resourced

 Stay focused
 Avoid letting evaluation purpose drift or languish

Post Script


Slide 7

Evaluation: LTBI Contact
Treatment in DC
Kim Seechuk, MPH
Bureau of TB Control
District of Columbia

DC’s Program Evaluation
 DC Quick Facts
 Plan Development
 Methods
 Results
 Lessons Learned

Washington DC Quick Facts
 61 Square Miles
 Eight Wards
 600,000 population
 50% Black
 13% Foreign born
 9% Hispanic
 59,000 median income
 18% below poverty

Number of Cases

District of Columbia TB Cases, 2000-2009
100
80
60
40
20
0

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

DC 85

74

82

79

81

55

Year

72

60

54

41

Evaluation Plan Development:
CDC Evaluation Framework

Step 1: Engage Stakeholders
 Conducted internal and external
stakeholder assessment
 Ultimately engaged internal stakeholders
only in evaluation planning

Program Objectives


Increase the proportion of contacts to
sputum AFB smear-positive TB patients
with newly diagnosed LTBI who start
treatment to 75%.



For above contacts who have started
treatment for LTBI, increase the
proportion of that complete treatment to
65%.

Step 2: Describe the Program
Baseline

 59 (32 sm+) cases in 2007
 90 LTBI contacts
 64 (71%) started treatment

 39 (61%) completed treatment
80
70
60
50
40

Baseline
Year

30
20
10
0
2006

2007

2008

2009

2010

Logic Model

Resources
 .5 FTE graduate intern x 6 months

 .1 FTE prevention specialist
 .1 FTE Program Manager
 Access to TB medical and program team

Step 3: Focus Evaluation Design
Evaluation Goals:
 Describe current processes for bringing
contacts with LTBI to treatment initiation and
completion;

 verify baseline findings;
 describe characteristics of contacts that
successfully begin and finish treatment;

 suggest changes to current process to
improved treatment initiation and completion.

Step 4: Gather Credible Evidence

Methods
Quantitative Review

− Program policies and protocols
− 2008 LTBI* medical/case management charts

 Observation of staff/patient interaction
− Physician, nurse case manager, TB investigator

 Qualitative Interviews
− patients who started and did/did not complete
treatment.
*number of LTBI contacts was very small, so expanded to all persons who
started LTBI treatment

Step 5: Justify Conclusions
Results

 Observations
 No actual written protocol for treatment offer
 Treatment offer was purview of the physician; no
 Consistent review of patient information sheet by
nurse on those who accepted

 Chart/Data Review – 2008 data
 33% (102/309) of LTBI patients completed therapy
 Black race and being foreign-born were associated
with not completing treatment
 History of incarceration was associated with
successfully completing treatment

Qualitative Interviews
 37 Patients contacted for interviews
 6 completed
 43% phone # wrong or disconnected
 30% never answered

Bust

Step 6: Ensure Use and Share
Lessons Learned
 Writing protocols-review & reinforce w/staff
 Determining steps to enhance treatment
offer beyond physician offer
 Language appropriate patient materials
 Considering:
 Increased case manager contact in first 2
weeks of starting treatment
 Pilot with community provider serving target
group (foreign born, black) to conduct LTBI
treatment follow up.

Lessons Learned (cont)
 High percentage of patients are transient
 Get multiple sources of locating information

 Check assumptions about what staff think is
happening

 Be realistic about what can be accomplished
 Assure data sources are easily accessed
 Assure evaluation is properly resourced

 Stay focused
 Avoid letting evaluation purpose drift or languish

Post Script


Slide 8

Evaluation: LTBI Contact
Treatment in DC
Kim Seechuk, MPH
Bureau of TB Control
District of Columbia

DC’s Program Evaluation
 DC Quick Facts
 Plan Development
 Methods
 Results
 Lessons Learned

Washington DC Quick Facts
 61 Square Miles
 Eight Wards
 600,000 population
 50% Black
 13% Foreign born
 9% Hispanic
 59,000 median income
 18% below poverty

Number of Cases

District of Columbia TB Cases, 2000-2009
100
80
60
40
20
0

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

DC 85

74

82

79

81

55

Year

72

60

54

41

Evaluation Plan Development:
CDC Evaluation Framework

Step 1: Engage Stakeholders
 Conducted internal and external
stakeholder assessment
 Ultimately engaged internal stakeholders
only in evaluation planning

Program Objectives


Increase the proportion of contacts to
sputum AFB smear-positive TB patients
with newly diagnosed LTBI who start
treatment to 75%.



For above contacts who have started
treatment for LTBI, increase the
proportion of that complete treatment to
65%.

Step 2: Describe the Program
Baseline

 59 (32 sm+) cases in 2007
 90 LTBI contacts
 64 (71%) started treatment

 39 (61%) completed treatment
80
70
60
50
40

Baseline
Year

30
20
10
0
2006

2007

2008

2009

2010

Logic Model

Resources
 .5 FTE graduate intern x 6 months

 .1 FTE prevention specialist
 .1 FTE Program Manager
 Access to TB medical and program team

Step 3: Focus Evaluation Design
Evaluation Goals:
 Describe current processes for bringing
contacts with LTBI to treatment initiation and
completion;

 verify baseline findings;
 describe characteristics of contacts that
successfully begin and finish treatment;

 suggest changes to current process to
improved treatment initiation and completion.

Step 4: Gather Credible Evidence

Methods
Quantitative Review

− Program policies and protocols
− 2008 LTBI* medical/case management charts

 Observation of staff/patient interaction
− Physician, nurse case manager, TB investigator

 Qualitative Interviews
− patients who started and did/did not complete
treatment.
*number of LTBI contacts was very small, so expanded to all persons who
started LTBI treatment

Step 5: Justify Conclusions
Results

 Observations
 No actual written protocol for treatment offer
 Treatment offer was purview of the physician; no
 Consistent review of patient information sheet by
nurse on those who accepted

 Chart/Data Review – 2008 data
 33% (102/309) of LTBI patients completed therapy
 Black race and being foreign-born were associated
with not completing treatment
 History of incarceration was associated with
successfully completing treatment

Qualitative Interviews
 37 Patients contacted for interviews
 6 completed
 43% phone # wrong or disconnected
 30% never answered

Bust

Step 6: Ensure Use and Share
Lessons Learned
 Writing protocols-review & reinforce w/staff
 Determining steps to enhance treatment
offer beyond physician offer
 Language appropriate patient materials
 Considering:
 Increased case manager contact in first 2
weeks of starting treatment
 Pilot with community provider serving target
group (foreign born, black) to conduct LTBI
treatment follow up.

Lessons Learned (cont)
 High percentage of patients are transient
 Get multiple sources of locating information

 Check assumptions about what staff think is
happening

 Be realistic about what can be accomplished
 Assure data sources are easily accessed
 Assure evaluation is properly resourced

 Stay focused
 Avoid letting evaluation purpose drift or languish

Post Script


Slide 9

Evaluation: LTBI Contact
Treatment in DC
Kim Seechuk, MPH
Bureau of TB Control
District of Columbia

DC’s Program Evaluation
 DC Quick Facts
 Plan Development
 Methods
 Results
 Lessons Learned

Washington DC Quick Facts
 61 Square Miles
 Eight Wards
 600,000 population
 50% Black
 13% Foreign born
 9% Hispanic
 59,000 median income
 18% below poverty

Number of Cases

District of Columbia TB Cases, 2000-2009
100
80
60
40
20
0

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

DC 85

74

82

79

81

55

Year

72

60

54

41

Evaluation Plan Development:
CDC Evaluation Framework

Step 1: Engage Stakeholders
 Conducted internal and external
stakeholder assessment
 Ultimately engaged internal stakeholders
only in evaluation planning

Program Objectives


Increase the proportion of contacts to
sputum AFB smear-positive TB patients
with newly diagnosed LTBI who start
treatment to 75%.



For above contacts who have started
treatment for LTBI, increase the
proportion of that complete treatment to
65%.

Step 2: Describe the Program
Baseline

 59 (32 sm+) cases in 2007
 90 LTBI contacts
 64 (71%) started treatment

 39 (61%) completed treatment
80
70
60
50
40

Baseline
Year

30
20
10
0
2006

2007

2008

2009

2010

Logic Model

Resources
 .5 FTE graduate intern x 6 months

 .1 FTE prevention specialist
 .1 FTE Program Manager
 Access to TB medical and program team

Step 3: Focus Evaluation Design
Evaluation Goals:
 Describe current processes for bringing
contacts with LTBI to treatment initiation and
completion;

 verify baseline findings;
 describe characteristics of contacts that
successfully begin and finish treatment;

 suggest changes to current process to
improved treatment initiation and completion.

Step 4: Gather Credible Evidence

Methods
Quantitative Review

− Program policies and protocols
− 2008 LTBI* medical/case management charts

 Observation of staff/patient interaction
− Physician, nurse case manager, TB investigator

 Qualitative Interviews
− patients who started and did/did not complete
treatment.
*number of LTBI contacts was very small, so expanded to all persons who
started LTBI treatment

Step 5: Justify Conclusions
Results

 Observations
 No actual written protocol for treatment offer
 Treatment offer was purview of the physician; no
 Consistent review of patient information sheet by
nurse on those who accepted

 Chart/Data Review – 2008 data
 33% (102/309) of LTBI patients completed therapy
 Black race and being foreign-born were associated
with not completing treatment
 History of incarceration was associated with
successfully completing treatment

Qualitative Interviews
 37 Patients contacted for interviews
 6 completed
 43% phone # wrong or disconnected
 30% never answered

Bust

Step 6: Ensure Use and Share
Lessons Learned
 Writing protocols-review & reinforce w/staff
 Determining steps to enhance treatment
offer beyond physician offer
 Language appropriate patient materials
 Considering:
 Increased case manager contact in first 2
weeks of starting treatment
 Pilot with community provider serving target
group (foreign born, black) to conduct LTBI
treatment follow up.

Lessons Learned (cont)
 High percentage of patients are transient
 Get multiple sources of locating information

 Check assumptions about what staff think is
happening

 Be realistic about what can be accomplished
 Assure data sources are easily accessed
 Assure evaluation is properly resourced

 Stay focused
 Avoid letting evaluation purpose drift or languish

Post Script


Slide 10

Evaluation: LTBI Contact
Treatment in DC
Kim Seechuk, MPH
Bureau of TB Control
District of Columbia

DC’s Program Evaluation
 DC Quick Facts
 Plan Development
 Methods
 Results
 Lessons Learned

Washington DC Quick Facts
 61 Square Miles
 Eight Wards
 600,000 population
 50% Black
 13% Foreign born
 9% Hispanic
 59,000 median income
 18% below poverty

Number of Cases

District of Columbia TB Cases, 2000-2009
100
80
60
40
20
0

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

DC 85

74

82

79

81

55

Year

72

60

54

41

Evaluation Plan Development:
CDC Evaluation Framework

Step 1: Engage Stakeholders
 Conducted internal and external
stakeholder assessment
 Ultimately engaged internal stakeholders
only in evaluation planning

Program Objectives


Increase the proportion of contacts to
sputum AFB smear-positive TB patients
with newly diagnosed LTBI who start
treatment to 75%.



For above contacts who have started
treatment for LTBI, increase the
proportion of that complete treatment to
65%.

Step 2: Describe the Program
Baseline

 59 (32 sm+) cases in 2007
 90 LTBI contacts
 64 (71%) started treatment

 39 (61%) completed treatment
80
70
60
50
40

Baseline
Year

30
20
10
0
2006

2007

2008

2009

2010

Logic Model

Resources
 .5 FTE graduate intern x 6 months

 .1 FTE prevention specialist
 .1 FTE Program Manager
 Access to TB medical and program team

Step 3: Focus Evaluation Design
Evaluation Goals:
 Describe current processes for bringing
contacts with LTBI to treatment initiation and
completion;

 verify baseline findings;
 describe characteristics of contacts that
successfully begin and finish treatment;

 suggest changes to current process to
improved treatment initiation and completion.

Step 4: Gather Credible Evidence

Methods
Quantitative Review

− Program policies and protocols
− 2008 LTBI* medical/case management charts

 Observation of staff/patient interaction
− Physician, nurse case manager, TB investigator

 Qualitative Interviews
− patients who started and did/did not complete
treatment.
*number of LTBI contacts was very small, so expanded to all persons who
started LTBI treatment

Step 5: Justify Conclusions
Results

 Observations
 No actual written protocol for treatment offer
 Treatment offer was purview of the physician; no
 Consistent review of patient information sheet by
nurse on those who accepted

 Chart/Data Review – 2008 data
 33% (102/309) of LTBI patients completed therapy
 Black race and being foreign-born were associated
with not completing treatment
 History of incarceration was associated with
successfully completing treatment

Qualitative Interviews
 37 Patients contacted for interviews
 6 completed
 43% phone # wrong or disconnected
 30% never answered

Bust

Step 6: Ensure Use and Share
Lessons Learned
 Writing protocols-review & reinforce w/staff
 Determining steps to enhance treatment
offer beyond physician offer
 Language appropriate patient materials
 Considering:
 Increased case manager contact in first 2
weeks of starting treatment
 Pilot with community provider serving target
group (foreign born, black) to conduct LTBI
treatment follow up.

Lessons Learned (cont)
 High percentage of patients are transient
 Get multiple sources of locating information

 Check assumptions about what staff think is
happening

 Be realistic about what can be accomplished
 Assure data sources are easily accessed
 Assure evaluation is properly resourced

 Stay focused
 Avoid letting evaluation purpose drift or languish

Post Script


Slide 11

Evaluation: LTBI Contact
Treatment in DC
Kim Seechuk, MPH
Bureau of TB Control
District of Columbia

DC’s Program Evaluation
 DC Quick Facts
 Plan Development
 Methods
 Results
 Lessons Learned

Washington DC Quick Facts
 61 Square Miles
 Eight Wards
 600,000 population
 50% Black
 13% Foreign born
 9% Hispanic
 59,000 median income
 18% below poverty

Number of Cases

District of Columbia TB Cases, 2000-2009
100
80
60
40
20
0

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

DC 85

74

82

79

81

55

Year

72

60

54

41

Evaluation Plan Development:
CDC Evaluation Framework

Step 1: Engage Stakeholders
 Conducted internal and external
stakeholder assessment
 Ultimately engaged internal stakeholders
only in evaluation planning

Program Objectives


Increase the proportion of contacts to
sputum AFB smear-positive TB patients
with newly diagnosed LTBI who start
treatment to 75%.



For above contacts who have started
treatment for LTBI, increase the
proportion of that complete treatment to
65%.

Step 2: Describe the Program
Baseline

 59 (32 sm+) cases in 2007
 90 LTBI contacts
 64 (71%) started treatment

 39 (61%) completed treatment
80
70
60
50
40

Baseline
Year

30
20
10
0
2006

2007

2008

2009

2010

Logic Model

Resources
 .5 FTE graduate intern x 6 months

 .1 FTE prevention specialist
 .1 FTE Program Manager
 Access to TB medical and program team

Step 3: Focus Evaluation Design
Evaluation Goals:
 Describe current processes for bringing
contacts with LTBI to treatment initiation and
completion;

 verify baseline findings;
 describe characteristics of contacts that
successfully begin and finish treatment;

 suggest changes to current process to
improved treatment initiation and completion.

Step 4: Gather Credible Evidence

Methods
Quantitative Review

− Program policies and protocols
− 2008 LTBI* medical/case management charts

 Observation of staff/patient interaction
− Physician, nurse case manager, TB investigator

 Qualitative Interviews
− patients who started and did/did not complete
treatment.
*number of LTBI contacts was very small, so expanded to all persons who
started LTBI treatment

Step 5: Justify Conclusions
Results

 Observations
 No actual written protocol for treatment offer
 Treatment offer was purview of the physician; no
 Consistent review of patient information sheet by
nurse on those who accepted

 Chart/Data Review – 2008 data
 33% (102/309) of LTBI patients completed therapy
 Black race and being foreign-born were associated
with not completing treatment
 History of incarceration was associated with
successfully completing treatment

Qualitative Interviews
 37 Patients contacted for interviews
 6 completed
 43% phone # wrong or disconnected
 30% never answered

Bust

Step 6: Ensure Use and Share
Lessons Learned
 Writing protocols-review & reinforce w/staff
 Determining steps to enhance treatment
offer beyond physician offer
 Language appropriate patient materials
 Considering:
 Increased case manager contact in first 2
weeks of starting treatment
 Pilot with community provider serving target
group (foreign born, black) to conduct LTBI
treatment follow up.

Lessons Learned (cont)
 High percentage of patients are transient
 Get multiple sources of locating information

 Check assumptions about what staff think is
happening

 Be realistic about what can be accomplished
 Assure data sources are easily accessed
 Assure evaluation is properly resourced

 Stay focused
 Avoid letting evaluation purpose drift or languish

Post Script


Slide 12

Evaluation: LTBI Contact
Treatment in DC
Kim Seechuk, MPH
Bureau of TB Control
District of Columbia

DC’s Program Evaluation
 DC Quick Facts
 Plan Development
 Methods
 Results
 Lessons Learned

Washington DC Quick Facts
 61 Square Miles
 Eight Wards
 600,000 population
 50% Black
 13% Foreign born
 9% Hispanic
 59,000 median income
 18% below poverty

Number of Cases

District of Columbia TB Cases, 2000-2009
100
80
60
40
20
0

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

DC 85

74

82

79

81

55

Year

72

60

54

41

Evaluation Plan Development:
CDC Evaluation Framework

Step 1: Engage Stakeholders
 Conducted internal and external
stakeholder assessment
 Ultimately engaged internal stakeholders
only in evaluation planning

Program Objectives


Increase the proportion of contacts to
sputum AFB smear-positive TB patients
with newly diagnosed LTBI who start
treatment to 75%.



For above contacts who have started
treatment for LTBI, increase the
proportion of that complete treatment to
65%.

Step 2: Describe the Program
Baseline

 59 (32 sm+) cases in 2007
 90 LTBI contacts
 64 (71%) started treatment

 39 (61%) completed treatment
80
70
60
50
40

Baseline
Year

30
20
10
0
2006

2007

2008

2009

2010

Logic Model

Resources
 .5 FTE graduate intern x 6 months

 .1 FTE prevention specialist
 .1 FTE Program Manager
 Access to TB medical and program team

Step 3: Focus Evaluation Design
Evaluation Goals:
 Describe current processes for bringing
contacts with LTBI to treatment initiation and
completion;

 verify baseline findings;
 describe characteristics of contacts that
successfully begin and finish treatment;

 suggest changes to current process to
improved treatment initiation and completion.

Step 4: Gather Credible Evidence

Methods
Quantitative Review

− Program policies and protocols
− 2008 LTBI* medical/case management charts

 Observation of staff/patient interaction
− Physician, nurse case manager, TB investigator

 Qualitative Interviews
− patients who started and did/did not complete
treatment.
*number of LTBI contacts was very small, so expanded to all persons who
started LTBI treatment

Step 5: Justify Conclusions
Results

 Observations
 No actual written protocol for treatment offer
 Treatment offer was purview of the physician; no
 Consistent review of patient information sheet by
nurse on those who accepted

 Chart/Data Review – 2008 data
 33% (102/309) of LTBI patients completed therapy
 Black race and being foreign-born were associated
with not completing treatment
 History of incarceration was associated with
successfully completing treatment

Qualitative Interviews
 37 Patients contacted for interviews
 6 completed
 43% phone # wrong or disconnected
 30% never answered

Bust

Step 6: Ensure Use and Share
Lessons Learned
 Writing protocols-review & reinforce w/staff
 Determining steps to enhance treatment
offer beyond physician offer
 Language appropriate patient materials
 Considering:
 Increased case manager contact in first 2
weeks of starting treatment
 Pilot with community provider serving target
group (foreign born, black) to conduct LTBI
treatment follow up.

Lessons Learned (cont)
 High percentage of patients are transient
 Get multiple sources of locating information

 Check assumptions about what staff think is
happening

 Be realistic about what can be accomplished
 Assure data sources are easily accessed
 Assure evaluation is properly resourced

 Stay focused
 Avoid letting evaluation purpose drift or languish

Post Script


Slide 13

Evaluation: LTBI Contact
Treatment in DC
Kim Seechuk, MPH
Bureau of TB Control
District of Columbia

DC’s Program Evaluation
 DC Quick Facts
 Plan Development
 Methods
 Results
 Lessons Learned

Washington DC Quick Facts
 61 Square Miles
 Eight Wards
 600,000 population
 50% Black
 13% Foreign born
 9% Hispanic
 59,000 median income
 18% below poverty

Number of Cases

District of Columbia TB Cases, 2000-2009
100
80
60
40
20
0

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

DC 85

74

82

79

81

55

Year

72

60

54

41

Evaluation Plan Development:
CDC Evaluation Framework

Step 1: Engage Stakeholders
 Conducted internal and external
stakeholder assessment
 Ultimately engaged internal stakeholders
only in evaluation planning

Program Objectives


Increase the proportion of contacts to
sputum AFB smear-positive TB patients
with newly diagnosed LTBI who start
treatment to 75%.



For above contacts who have started
treatment for LTBI, increase the
proportion of that complete treatment to
65%.

Step 2: Describe the Program
Baseline

 59 (32 sm+) cases in 2007
 90 LTBI contacts
 64 (71%) started treatment

 39 (61%) completed treatment
80
70
60
50
40

Baseline
Year

30
20
10
0
2006

2007

2008

2009

2010

Logic Model

Resources
 .5 FTE graduate intern x 6 months

 .1 FTE prevention specialist
 .1 FTE Program Manager
 Access to TB medical and program team

Step 3: Focus Evaluation Design
Evaluation Goals:
 Describe current processes for bringing
contacts with LTBI to treatment initiation and
completion;

 verify baseline findings;
 describe characteristics of contacts that
successfully begin and finish treatment;

 suggest changes to current process to
improved treatment initiation and completion.

Step 4: Gather Credible Evidence

Methods
Quantitative Review

− Program policies and protocols
− 2008 LTBI* medical/case management charts

 Observation of staff/patient interaction
− Physician, nurse case manager, TB investigator

 Qualitative Interviews
− patients who started and did/did not complete
treatment.
*number of LTBI contacts was very small, so expanded to all persons who
started LTBI treatment

Step 5: Justify Conclusions
Results

 Observations
 No actual written protocol for treatment offer
 Treatment offer was purview of the physician; no
 Consistent review of patient information sheet by
nurse on those who accepted

 Chart/Data Review – 2008 data
 33% (102/309) of LTBI patients completed therapy
 Black race and being foreign-born were associated
with not completing treatment
 History of incarceration was associated with
successfully completing treatment

Qualitative Interviews
 37 Patients contacted for interviews
 6 completed
 43% phone # wrong or disconnected
 30% never answered

Bust

Step 6: Ensure Use and Share
Lessons Learned
 Writing protocols-review & reinforce w/staff
 Determining steps to enhance treatment
offer beyond physician offer
 Language appropriate patient materials
 Considering:
 Increased case manager contact in first 2
weeks of starting treatment
 Pilot with community provider serving target
group (foreign born, black) to conduct LTBI
treatment follow up.

Lessons Learned (cont)
 High percentage of patients are transient
 Get multiple sources of locating information

 Check assumptions about what staff think is
happening

 Be realistic about what can be accomplished
 Assure data sources are easily accessed
 Assure evaluation is properly resourced

 Stay focused
 Avoid letting evaluation purpose drift or languish

Post Script


Slide 14

Evaluation: LTBI Contact
Treatment in DC
Kim Seechuk, MPH
Bureau of TB Control
District of Columbia

DC’s Program Evaluation
 DC Quick Facts
 Plan Development
 Methods
 Results
 Lessons Learned

Washington DC Quick Facts
 61 Square Miles
 Eight Wards
 600,000 population
 50% Black
 13% Foreign born
 9% Hispanic
 59,000 median income
 18% below poverty

Number of Cases

District of Columbia TB Cases, 2000-2009
100
80
60
40
20
0

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

DC 85

74

82

79

81

55

Year

72

60

54

41

Evaluation Plan Development:
CDC Evaluation Framework

Step 1: Engage Stakeholders
 Conducted internal and external
stakeholder assessment
 Ultimately engaged internal stakeholders
only in evaluation planning

Program Objectives


Increase the proportion of contacts to
sputum AFB smear-positive TB patients
with newly diagnosed LTBI who start
treatment to 75%.



For above contacts who have started
treatment for LTBI, increase the
proportion of that complete treatment to
65%.

Step 2: Describe the Program
Baseline

 59 (32 sm+) cases in 2007
 90 LTBI contacts
 64 (71%) started treatment

 39 (61%) completed treatment
80
70
60
50
40

Baseline
Year

30
20
10
0
2006

2007

2008

2009

2010

Logic Model

Resources
 .5 FTE graduate intern x 6 months

 .1 FTE prevention specialist
 .1 FTE Program Manager
 Access to TB medical and program team

Step 3: Focus Evaluation Design
Evaluation Goals:
 Describe current processes for bringing
contacts with LTBI to treatment initiation and
completion;

 verify baseline findings;
 describe characteristics of contacts that
successfully begin and finish treatment;

 suggest changes to current process to
improved treatment initiation and completion.

Step 4: Gather Credible Evidence

Methods
Quantitative Review

− Program policies and protocols
− 2008 LTBI* medical/case management charts

 Observation of staff/patient interaction
− Physician, nurse case manager, TB investigator

 Qualitative Interviews
− patients who started and did/did not complete
treatment.
*number of LTBI contacts was very small, so expanded to all persons who
started LTBI treatment

Step 5: Justify Conclusions
Results

 Observations
 No actual written protocol for treatment offer
 Treatment offer was purview of the physician; no
 Consistent review of patient information sheet by
nurse on those who accepted

 Chart/Data Review – 2008 data
 33% (102/309) of LTBI patients completed therapy
 Black race and being foreign-born were associated
with not completing treatment
 History of incarceration was associated with
successfully completing treatment

Qualitative Interviews
 37 Patients contacted for interviews
 6 completed
 43% phone # wrong or disconnected
 30% never answered

Bust

Step 6: Ensure Use and Share
Lessons Learned
 Writing protocols-review & reinforce w/staff
 Determining steps to enhance treatment
offer beyond physician offer
 Language appropriate patient materials
 Considering:
 Increased case manager contact in first 2
weeks of starting treatment
 Pilot with community provider serving target
group (foreign born, black) to conduct LTBI
treatment follow up.

Lessons Learned (cont)
 High percentage of patients are transient
 Get multiple sources of locating information

 Check assumptions about what staff think is
happening

 Be realistic about what can be accomplished
 Assure data sources are easily accessed
 Assure evaluation is properly resourced

 Stay focused
 Avoid letting evaluation purpose drift or languish

Post Script


Slide 15

Evaluation: LTBI Contact
Treatment in DC
Kim Seechuk, MPH
Bureau of TB Control
District of Columbia

DC’s Program Evaluation
 DC Quick Facts
 Plan Development
 Methods
 Results
 Lessons Learned

Washington DC Quick Facts
 61 Square Miles
 Eight Wards
 600,000 population
 50% Black
 13% Foreign born
 9% Hispanic
 59,000 median income
 18% below poverty

Number of Cases

District of Columbia TB Cases, 2000-2009
100
80
60
40
20
0

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

DC 85

74

82

79

81

55

Year

72

60

54

41

Evaluation Plan Development:
CDC Evaluation Framework

Step 1: Engage Stakeholders
 Conducted internal and external
stakeholder assessment
 Ultimately engaged internal stakeholders
only in evaluation planning

Program Objectives


Increase the proportion of contacts to
sputum AFB smear-positive TB patients
with newly diagnosed LTBI who start
treatment to 75%.



For above contacts who have started
treatment for LTBI, increase the
proportion of that complete treatment to
65%.

Step 2: Describe the Program
Baseline

 59 (32 sm+) cases in 2007
 90 LTBI contacts
 64 (71%) started treatment

 39 (61%) completed treatment
80
70
60
50
40

Baseline
Year

30
20
10
0
2006

2007

2008

2009

2010

Logic Model

Resources
 .5 FTE graduate intern x 6 months

 .1 FTE prevention specialist
 .1 FTE Program Manager
 Access to TB medical and program team

Step 3: Focus Evaluation Design
Evaluation Goals:
 Describe current processes for bringing
contacts with LTBI to treatment initiation and
completion;

 verify baseline findings;
 describe characteristics of contacts that
successfully begin and finish treatment;

 suggest changes to current process to
improved treatment initiation and completion.

Step 4: Gather Credible Evidence

Methods
Quantitative Review

− Program policies and protocols
− 2008 LTBI* medical/case management charts

 Observation of staff/patient interaction
− Physician, nurse case manager, TB investigator

 Qualitative Interviews
− patients who started and did/did not complete
treatment.
*number of LTBI contacts was very small, so expanded to all persons who
started LTBI treatment

Step 5: Justify Conclusions
Results

 Observations
 No actual written protocol for treatment offer
 Treatment offer was purview of the physician; no
 Consistent review of patient information sheet by
nurse on those who accepted

 Chart/Data Review – 2008 data
 33% (102/309) of LTBI patients completed therapy
 Black race and being foreign-born were associated
with not completing treatment
 History of incarceration was associated with
successfully completing treatment

Qualitative Interviews
 37 Patients contacted for interviews
 6 completed
 43% phone # wrong or disconnected
 30% never answered

Bust

Step 6: Ensure Use and Share
Lessons Learned
 Writing protocols-review & reinforce w/staff
 Determining steps to enhance treatment
offer beyond physician offer
 Language appropriate patient materials
 Considering:
 Increased case manager contact in first 2
weeks of starting treatment
 Pilot with community provider serving target
group (foreign born, black) to conduct LTBI
treatment follow up.

Lessons Learned (cont)
 High percentage of patients are transient
 Get multiple sources of locating information

 Check assumptions about what staff think is
happening

 Be realistic about what can be accomplished
 Assure data sources are easily accessed
 Assure evaluation is properly resourced

 Stay focused
 Avoid letting evaluation purpose drift or languish

Post Script


Slide 16

Evaluation: LTBI Contact
Treatment in DC
Kim Seechuk, MPH
Bureau of TB Control
District of Columbia

DC’s Program Evaluation
 DC Quick Facts
 Plan Development
 Methods
 Results
 Lessons Learned

Washington DC Quick Facts
 61 Square Miles
 Eight Wards
 600,000 population
 50% Black
 13% Foreign born
 9% Hispanic
 59,000 median income
 18% below poverty

Number of Cases

District of Columbia TB Cases, 2000-2009
100
80
60
40
20
0

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

DC 85

74

82

79

81

55

Year

72

60

54

41

Evaluation Plan Development:
CDC Evaluation Framework

Step 1: Engage Stakeholders
 Conducted internal and external
stakeholder assessment
 Ultimately engaged internal stakeholders
only in evaluation planning

Program Objectives


Increase the proportion of contacts to
sputum AFB smear-positive TB patients
with newly diagnosed LTBI who start
treatment to 75%.



For above contacts who have started
treatment for LTBI, increase the
proportion of that complete treatment to
65%.

Step 2: Describe the Program
Baseline

 59 (32 sm+) cases in 2007
 90 LTBI contacts
 64 (71%) started treatment

 39 (61%) completed treatment
80
70
60
50
40

Baseline
Year

30
20
10
0
2006

2007

2008

2009

2010

Logic Model

Resources
 .5 FTE graduate intern x 6 months

 .1 FTE prevention specialist
 .1 FTE Program Manager
 Access to TB medical and program team

Step 3: Focus Evaluation Design
Evaluation Goals:
 Describe current processes for bringing
contacts with LTBI to treatment initiation and
completion;

 verify baseline findings;
 describe characteristics of contacts that
successfully begin and finish treatment;

 suggest changes to current process to
improved treatment initiation and completion.

Step 4: Gather Credible Evidence

Methods
Quantitative Review

− Program policies and protocols
− 2008 LTBI* medical/case management charts

 Observation of staff/patient interaction
− Physician, nurse case manager, TB investigator

 Qualitative Interviews
− patients who started and did/did not complete
treatment.
*number of LTBI contacts was very small, so expanded to all persons who
started LTBI treatment

Step 5: Justify Conclusions
Results

 Observations
 No actual written protocol for treatment offer
 Treatment offer was purview of the physician; no
 Consistent review of patient information sheet by
nurse on those who accepted

 Chart/Data Review – 2008 data
 33% (102/309) of LTBI patients completed therapy
 Black race and being foreign-born were associated
with not completing treatment
 History of incarceration was associated with
successfully completing treatment

Qualitative Interviews
 37 Patients contacted for interviews
 6 completed
 43% phone # wrong or disconnected
 30% never answered

Bust

Step 6: Ensure Use and Share
Lessons Learned
 Writing protocols-review & reinforce w/staff
 Determining steps to enhance treatment
offer beyond physician offer
 Language appropriate patient materials
 Considering:
 Increased case manager contact in first 2
weeks of starting treatment
 Pilot with community provider serving target
group (foreign born, black) to conduct LTBI
treatment follow up.

Lessons Learned (cont)
 High percentage of patients are transient
 Get multiple sources of locating information

 Check assumptions about what staff think is
happening

 Be realistic about what can be accomplished
 Assure data sources are easily accessed
 Assure evaluation is properly resourced

 Stay focused
 Avoid letting evaluation purpose drift or languish

Post Script


Slide 17

Evaluation: LTBI Contact
Treatment in DC
Kim Seechuk, MPH
Bureau of TB Control
District of Columbia

DC’s Program Evaluation
 DC Quick Facts
 Plan Development
 Methods
 Results
 Lessons Learned

Washington DC Quick Facts
 61 Square Miles
 Eight Wards
 600,000 population
 50% Black
 13% Foreign born
 9% Hispanic
 59,000 median income
 18% below poverty

Number of Cases

District of Columbia TB Cases, 2000-2009
100
80
60
40
20
0

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

DC 85

74

82

79

81

55

Year

72

60

54

41

Evaluation Plan Development:
CDC Evaluation Framework

Step 1: Engage Stakeholders
 Conducted internal and external
stakeholder assessment
 Ultimately engaged internal stakeholders
only in evaluation planning

Program Objectives


Increase the proportion of contacts to
sputum AFB smear-positive TB patients
with newly diagnosed LTBI who start
treatment to 75%.



For above contacts who have started
treatment for LTBI, increase the
proportion of that complete treatment to
65%.

Step 2: Describe the Program
Baseline

 59 (32 sm+) cases in 2007
 90 LTBI contacts
 64 (71%) started treatment

 39 (61%) completed treatment
80
70
60
50
40

Baseline
Year

30
20
10
0
2006

2007

2008

2009

2010

Logic Model

Resources
 .5 FTE graduate intern x 6 months

 .1 FTE prevention specialist
 .1 FTE Program Manager
 Access to TB medical and program team

Step 3: Focus Evaluation Design
Evaluation Goals:
 Describe current processes for bringing
contacts with LTBI to treatment initiation and
completion;

 verify baseline findings;
 describe characteristics of contacts that
successfully begin and finish treatment;

 suggest changes to current process to
improved treatment initiation and completion.

Step 4: Gather Credible Evidence

Methods
Quantitative Review

− Program policies and protocols
− 2008 LTBI* medical/case management charts

 Observation of staff/patient interaction
− Physician, nurse case manager, TB investigator

 Qualitative Interviews
− patients who started and did/did not complete
treatment.
*number of LTBI contacts was very small, so expanded to all persons who
started LTBI treatment

Step 5: Justify Conclusions
Results

 Observations
 No actual written protocol for treatment offer
 Treatment offer was purview of the physician; no
 Consistent review of patient information sheet by
nurse on those who accepted

 Chart/Data Review – 2008 data
 33% (102/309) of LTBI patients completed therapy
 Black race and being foreign-born were associated
with not completing treatment
 History of incarceration was associated with
successfully completing treatment

Qualitative Interviews
 37 Patients contacted for interviews
 6 completed
 43% phone # wrong or disconnected
 30% never answered

Bust

Step 6: Ensure Use and Share
Lessons Learned
 Writing protocols-review & reinforce w/staff
 Determining steps to enhance treatment
offer beyond physician offer
 Language appropriate patient materials
 Considering:
 Increased case manager contact in first 2
weeks of starting treatment
 Pilot with community provider serving target
group (foreign born, black) to conduct LTBI
treatment follow up.

Lessons Learned (cont)
 High percentage of patients are transient
 Get multiple sources of locating information

 Check assumptions about what staff think is
happening

 Be realistic about what can be accomplished
 Assure data sources are easily accessed
 Assure evaluation is properly resourced

 Stay focused
 Avoid letting evaluation purpose drift or languish

Post Script