Evaluating Tuberculosis Case Detection via Real-Time Monitoring of Tuberculosis Diagnostic Services
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Date
2011
Journal Title
Journal ISSN
Volume Title
Publisher
American journal of respiratory and critical care medicine
Abstract
Tuberculosis case-detection rates are below internationally
established targets in high-burden countries. Real-time monitoring
and evaluation of adherence to widely endorsed standards of
tuberculosis care might facilitate improved case finding.
Objectives: To monitor and evaluate the quality of tuberculosis casedetection
and management services in a low-income country with
a high incidence of tuberculosis.
Methods:We prospectively evaluated tuberculosis diagnostic services
at five primary health-care facilities in Uganda for 1 year, after introducing
a real-time, electronic performance-monitoring system. We
collecteddataonevery clinicalencounter,andmeasuredquality using
indicatorsderivedfromthe International StandardsofTuberculosisCare.
Measurements and Main Results: In 2009, there were 62,909 adult
primary-care visits.During the first quarter of 2009, clinicians referred
only21%of patients with cough greater than or equal to 2 weeks for
sputum smear microscopy and only 71% of patients with a positive
sputum examination for tuberculosis treatment. These proportions
increased to 53% and 84%, respectively, in the fourth quarter of
2009. The cumulative probability that a smear-positive patient with
cough greater than or equal to 2 weeks would be appropriately
evaluated and referred for treatment rose from 11% to 34% (P 5
0.005). The quarterly number of tuberculosis cases identified and
prescribed treatment also increased four-fold, from 5 to 21.
Conclusions: Pooradherence tointernationally acceptedstandards of
tuberculosis care improved after introduction of real-time performance
monitoring and was associated with increased tuberculosis
case detection. Real-time monitoring and evaluation can strengthen
health systems in low-income countries and facilitate operational
research on the effectiveness and sustainability of interventions to
improve tuberculosis case detection.
Description
Keywords
Tuberculosis, Diagnosis, Health care quality assurance, Operations research, Public health
Citation
Davis, J., Katamba, A., Vasquez, J., Crawford, E., Sserwanga, A., Kakeeto, S., ... & Cattamanchi, A. (2011). Evaluating tuberculosis case detection via real-time monitoring of tuberculosis diagnostic services. American journal of respiratory and critical care medicine, 184(3), 362-367. DOI: 10.1164/rccm.201012-1984OC