Effect of a hospital-based case management approach on treatment outcome of patients with tuberculosis.
OBJECTIVE
Tuberculosis (TB) continues to pose a heavy public health burden in Taiwan. This prospective study analyzed the factors influencing treatment outcome in patients with TB treated with and without a hospital-based case management (HBCM) approach in a referral center in Taipei.


METHODS
A register-based cohort study design was used to enroll all new cases of pulmonary or extrapulmonary TB from February 2003 to January 2004. The case manager served as the coordinator among patients, physicians and public health nurses, to facilitate compliance with anti-TB treatment. Treatment outcomes were assessed according to the consensus recommendations of the World Health Organization and the International Union Against Tuberculosis and Lung Disease.


RESULTS
Suspected or confirmed pulmonary or extrapulmonary TB was diagnosed in 524 patients in our hospital from February 2003 to January 2004. Fifty-two of these patients were excluded due to duplicate reporting, previous treatment or death before enrollment. Out of 472 patients enrolled, 103 whose original diagnosis was revised were further excluded, leaving 369 cases eligible for analysis. Patients with case management had a significantly higher rate of successful treatment (cured plus completed treatment) compared to patients without case management, (240/277, 86.6% vs. 67/92, 72.8%; p = 0.002). The overall successful treatment rate including both case and non-case management was 83.2% (307/369), which was higher than the nationwide surveillance data of 78.3% in 2002 and 69.4% in 2003.


CONCLUSIONS
Treatment of TB patients by a HBCM approach provides improved treatment outcomes compared to those without case management.
Lin
Rong-Luh
RL
Pulmonary Division, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan. rongluh@seed.net.tw
Lin
Fung-J
FJ
Wu
Chien-Liang
CL
Peng
Ming-Jen
MJ
Chen
Pei-Jan
PJ
Kuo
Hsu-Tah
HT
D000293:Adolescent; D000328:Adult; D000368:Aged; D019090:Case Management; D005260:Female; D006739:Hospital Administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy*