title: Health professionals' experiences of tuberculosis cohort audit in the North West of England: a qualitative study.
abstract: OBJECTIVE
  Tuberculosis cohort audit (TBCA) was introduced across the North West (NW) of England in 2012 as an ongoing, multidisciplinary, systematic case review process, designed to improve clinical and public health practice. TBCA has not previously been introduced across such a large and socioeconomically diverse area in England, nor has it undergone formal, qualitative evaluation. This study explored health professionals' experiences of the process after 1515 cases had been reviewed.
  
  
  METHODS
  Qualitative study using semistructured interviews. Respondents were purposively sampled from 3 groups involved in the NW TBCA: (1) TB nurse specialists, (2) consultant physicians and (3) public health practitioners. Data from the 26 respondents were triangulated with further interviews with key informants from the TBCA Steering Group and through observation of TBCA meetings.
  
  
  METHODS
  Interview transcripts were analysed thematically using the framework approach.
  
  
  RESULTS
  Participants described the evolution of a valuable 'community of practice' where interprofessional exchange of experience and ideas has led to enhanced mutual respect between different roles and a shared sense of purpose. This multidisciplinary, regional approach to TB cohort audit has promoted local and regional team working, exchange of good practices and local initiatives to improve care. There is strong ownership of the process from public health professionals, nurses and clinicians; all groups want it to continue. TBCA is regarded as a tool for quality improvement that improves patient safety.
  
  
  CONCLUSIONS
  TBCA provides peer support and learning for management of a relatively rare, but important infectious disease through discussion in a no-blame atmosphere. It is seen as an effective quality improvement strategy which enhances TB care, control and patient safety. Continuing success will require increased engagement of consultant physicians and public health practitioners, a secure and ongoing funding stream and establishment of clear reporting mechanisms within the public health system.
authors.affiliation: Department of Clinical Sciences and Centre for Applied Health Research & Delivery, Liverpool School of Tropical Medicine, Liverpool, Merseyside, UK.
authors.forename: Selina K
authors.identifier: http://orcid.org/0000-0002-5490-0528
authors.initials: SK
authors.lastname: Wallis
authors.affiliation: Department of Public Health and Policy, University of Liverpool, Liverpool, Merseyside, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Jehan
authors.affiliation: Manchester Royal Infirmary, Manchester, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Woodhead
authors.affiliation: Public Health England, Liverpool, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Cleary
authors.affiliation: Public Health England, Liverpool, UK.
authors.forename: Katie
authors.initials: K
authors.lastname: Dee
authors.affiliation: Bolton NHS Trust, Bolton, UK.
authors.forename: Stacey
authors.initials: S
authors.lastname: Farrow
authors.affiliation: North Manchester General Hospital, Manchester, UK.
authors.forename: Paddy
authors.initials: P
authors.lastname: McMaster
authors.affiliation: Public Health England, Liverpool, UK.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Wake
authors.affiliation: Liverpool Community Health Trust, Liverpool, UK.
authors.forename: Jenny
authors.initials: J
authors.lastname: Walker
authors.affiliation: Department of Clinical Sciences and Centre for Applied Health Research & Delivery, Liverpool School of Tropical Medicine, Liverpool, Merseyside, UK Liverpool Heart and Chest Hospital, Liverpool, UK.
authors.forename: D J
authors.identifier: http://orcid.org/0000-0003-0633-3060
authors.initials: DJ
authors.lastname: Sloan
authors.affiliation: Department of Clinical Sciences and Centre for Applied Health Research & Delivery, Liverpool School of Tropical Medicine, Liverpool, Merseyside, UK Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: S B
authors.initials: SB
authors.lastname: Squire
mesh_terms: D054869:Clinical Audit; D015988:Cohort Effect; D004739:England; D006282:Health Personnel; D006801:Humans; D007407:Interviews as Topic; D036301:Qualitative Research; D014376:Tuberculosis / Q000453:epidemiology* / Q000517:prevention & control*
keywords: HEALTH SERVICES ADMINISTRATION & MANAGEMENT; PUBLIC HEALTH; QUALITATIVE RESEARCH; THORACIC MEDICINE