Evaluation of case management in tuberculosis control: a three-year effort to improve case management practices in New York City.
OBJECTIVE
To describe a 3-year effort to identify factors associated with lapses in case management (CM) and to improve CM practices by New York City Bureau of Tuberculosis Control (BTBC) staff.


METHODS
Evaluation of the CM of TB cases reported in the second quarter of 2003 and comparison of results with the findings of a similar review conducted in 2002. Implementation of strategies to target areas in need of improvement and identification of interventions that contribute to improved work practices.


RESULTS
From 2002 to 2003, significant improvements were found in some CM indicators, such as patient education about the importance of directly observed therapy (32% vs. 74%), importance of monthly follow-up (24% vs. 51%) and potential for development of drug resistance (36% vs. 61%). Informing patients about the availability of services provided by the BTBC also improved (16% vs. 59%); however, timeliness and documentation of CM activities and implementation of supervisory activities remained poor. Supervisors largely attributed this lack of improvement to poor documentation of work actually performed.


CONCLUSIONS
These evaluations identified lapses in CM practices and program supervision. The findings were used to adjust protocols, target interventions, and focus education and training to improve work practices.
Udeagu
C-C N
CC
Field Services Unit, New York City Department of Health and Mental Hygiene, New York, New York 10013, USA. cudeagu@health.nyc.gov
Dorsinville
M S
MS
Munsiff
S S
SS
Vilnyanskaya
Y
Y
Wang
I
I
D019090:Case Management / Q000458:organization & administration*; D003140:Communicable Disease Control / Q000379:methods*; D006801:Humans; D009519:New York City / Q000453:epidemiology; D010353:Patient Education as Topic / Q000379:methods; D017410:Practice Guidelines as Topic; D015397:Program Evaluation / Q000639:trends*; D012189:Retrospective Studies; D014376:Tuberculosis / Q000453:epidemiology / Q000517:prevention & control*; D014505:Urban Population