TB Contact Investigation Albuquerque, New Mexico April 22-23, 23 2010 Data Management Benita Cook, RN, BS April 23, 2010 Contact Investigation Data Management Benita Cook, RN, BS Region 5 TB Nurse Coordinator NMDOH/Public Health Division 1
Overview In-field Paper Management Reporting Computer Methods for Tracking Contacts Between Jurisdictions Across the Border It s a tough job, but somebody s got to do it. 2
In-field Paper Management Getting Started Outside agencies have own forms Feel free to adapt following forms for your use NMDOH Forms on Intranet TB 012-Contact Investigation Interview Guide-01-0909 TB 013A-Report of Contacts-01 01-0909 TB 013B-Continuation Report of Contacts-01 01-0909 Other NMDOH Requirements In-field Paper Management Contact Investigation Interview Guide Useful for locating contact sources for complicated CIs involving lots of different locations (Handout TB 012) Excellent guide for those who perform CIs rarely or infrequently Useful for investigators who are not the TB case manager, has space for index case s demographic and condition info 3
In-field Paper Management Contact Investigation Interview Guide (cont) Covers household, visitors, group activities, childcare, school, workplace, carpooling, vacations, etc. Contains definitions regarding length of time of exposure and sizes and ventilation of shared spaces. Worksheet, does not have to be submitted to TB Program In-field Paper Management Report of Contacts Line listing with demographic, exposure and condition data of screened contacts (Handout TB 013A) Also has demographic and status info of Index case/suspect Please be sure to include Date Contact Broken this determines timing of final TST (8-10 weeks after last exposure date) 4
In-field Paper Management Report of Contacts (cont) Continuation of Report of Tuberculosis Contacts (Handout TB 013B) is second and subsequent pages of contact report Working field database will add info during course of CI Submit to TB Program periodically during course of investigation In-field Paper Management Other NMDOH Requirements Privacy Notice and Acknowledgement Form (HIPAA 101b) Targeted TST Screening Form (TB 001) Complete for each contact screened Use this info to complete Report of Contacts 5
Reporting TB Program contract t nurse to call PHN and offer assistance within one week of case being reported Submit initial CI forms (TB 013A/B) within 30 days after case reporting date Submit interim CI forms (TB 013A/B, work in progress) NLT 90 days after case reported Final, completed CI forms should be submitted NLT 12 months after case was reported Reporting (cont) Non-DOH case contacts t reporting will vary depending on institution/facility, but TB Program contract nurse, nurse consultant or PHN will call to offer assistance and guidance Submit info re TSTs, CXRs, conversions, etc to TB Program staff so reporting can be done and treatment offered as indicated 6
Computer Methods Access Data Base is the system used by the TB Program in Santa Fe to record infectious TB cases with all of their contacts An annual report is generated e to the CDC C with this information CDC grades us on how well we evaluate our contacts Computer Methods Non-DOH institutions/facilities will document according to their policies and protocols using their specific systems NMDOH presently uses BEHR for client documentation 7
Computer Methods BEHR BEHR is not really designed for contact investigation documentation, but this is the method I use for the present Initial testing session is appointed as Outreach, since how many contacts and their demographic info is unknown The Outreach appointment is acknowledged and number of clients evaluated is entered as with other outreach events Computer Methods BEHR (cont) Contacts who have had TSTs placed or were sent for CXR are registered and appointed for readings and follow-up When client is seen a note is generated using either the TB Testing Exam or Results templates Encounter is then completed using appropriate diagnosis codes and charges Privacy Practices Acknowledgement form (HIPAA 101b), Targeted TST Screening Form (TB 001), CXR results, etc are scanned in 8
Computer Methods BEHR (cont) Info is then available in system for Subsequent treatment visits Tasking to TB Program consultants, PHNs or physicians Future access of testing results or treatment history Revised template notes are being developed Contacts to a case may reside in another city, state or country, so a referral or interjurisdictional notification may have to be done. Call the TB Program office in Santa Fe with information regarding the location of contacts. 9
If the contact lives in Another city in NM, the PHO in that county may be requested to assist in testing contacts Another state in the US, an Interjurisdictional Notification will be sent to the TB Program in that state Another country, a program such as Migrant Clinicians Network (TB Net) or Cure TB may be notified to arrange for testing in that country Interjurisdictional TB Notification This form has demographic and status info regarding the TB case and/or contacts needing to be followed in another US state (Handout NTCA 3-2002) The TB Program will fill out and notify the other state for you, so please provide accurate address, phone number and other contact info. 10
Interjurisdictional TB Notification (cont) You may receive this form if you are called upon to assist in a CI or to provide treatment for a TB Disease or LTBI case from another state. For privacy, there may only be info regarding smear, culture and sensitivity results of the case. Interjurisdictional TB Notification (cont) The Interjurisdictional TB Notification may be accompanied by another form, the Interjurisdictional TB Notification Follow-up (Handout NTCA 5-2002), a form to provide the referring jurisdiction with feedback regarding the outcome of the case or CI. If there are multiple contacts on which to report testing/treatment outcomes, we can send a copy of the NMDOH Report of TB Contacts on the specified contacts. 11
Across the Border A program such as Migrant Clinicians Network (TB Net) or Cure TB may be notified to arrange for testing in other countries The client has to give consent for TB Net to coordinate care in the other country, so you may be called upon to get the consent signature and an accurate address, phone number and contact info in the other country (Good Luck!) (Handouts-not not numbered) Again the TB Program will make these referrals for you so don t worry! Across the Border (cont) However, in different countries with different resources and policies regarding treatment of public health conditions, it may be easier to get treatment for an active case than testing for contacts. Most countries do not provide treatment for LTBI. The same thing may apply to different US states while they will test contacts, many do not provide LTBI treatment without cost. 12
Across the Border (cont) Juarez MX has a wonderful program called Proyecto Juntos, which is funded by Texas Department of State Health Services together with the Chihuahua Health System. Some of the TB Consultants t may be able to refer directly to them instead of having to go through TB Net or Cure TB. Questions? 13
You can do it! Thank you! 14