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Missed opportunities in TB diagnosis: a TB Process-Based Performance Review tool to evaluate and improve clinical care

BACKGROUND: Traditional tuberculosis (TB) treatment outcome measures, such as cure rate, do not provide insight into the underlying reasons for missing clinical targets. We evaluated a TB Process-Based Performance Review (TB-PBPR) tool, developed to identify "missed opportunities" for time...

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Autores principales: Field, Nigel, Murray, Jill, Wong, Michelle L, Dowdeswell, Rob, Dudumayo, Ntomboxolo, Rametsi, Lesego, Martinson, Neil, Lipman, Marc, Glynn, Judith R, Sonnenberg, Pam
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3051909/
https://www.ncbi.nlm.nih.gov/pubmed/21342493
http://dx.doi.org/10.1186/1471-2458-11-127
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author Field, Nigel
Murray, Jill
Wong, Michelle L
Dowdeswell, Rob
Dudumayo, Ntomboxolo
Rametsi, Lesego
Martinson, Neil
Lipman, Marc
Glynn, Judith R
Sonnenberg, Pam
author_facet Field, Nigel
Murray, Jill
Wong, Michelle L
Dowdeswell, Rob
Dudumayo, Ntomboxolo
Rametsi, Lesego
Martinson, Neil
Lipman, Marc
Glynn, Judith R
Sonnenberg, Pam
author_sort Field, Nigel
collection PubMed
description BACKGROUND: Traditional tuberculosis (TB) treatment outcome measures, such as cure rate, do not provide insight into the underlying reasons for missing clinical targets. We evaluated a TB Process-Based Performance Review (TB-PBPR) tool, developed to identify "missed opportunities" for timely and accurate diagnosis of TB. The tool enables performance assessment at the level of process and quality of care. METHODS: The TB-PBPR tool is a single-page structured flow-sheet that identifies 14 clinical actions (grouped into elicited symptoms, clinical examination and investigations). Medical records from selected deceased patients were reviewed at two South African mine hospitals (A = 56 cases; B = 26 cases), a South African teaching hospital (C = 20 cases) and a UK teaching hospital (D = 13 cases). RESULTS: In hospital A, where autopsy was routine, TB was missed in life in 52% (23/44) of cases and was wrongly attributed as the cause of death in 16% (18/110). Clinical omissions were identified at each hospital and at every stage of clinical management. For example, recording of chest symptoms was omitted in up to 39% of cases, sputum smear examination in up to 85% and chest radiograph in up to 38% of cases respectively. CONCLUSIONS: This study introduces the TB-PBPR tool as a novel method to review and evaluate clinical performance in TB management. We found that simple clinical actions were omitted in many cases. The tool, in conjunction with a manual describing best practice, is adaptable to a range of settings, is educational and enables detailed feedback within a TB programme. The TB-PBPR tool and manual are both freely available for general use.
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spelling pubmed-30519092011-03-10 Missed opportunities in TB diagnosis: a TB Process-Based Performance Review tool to evaluate and improve clinical care Field, Nigel Murray, Jill Wong, Michelle L Dowdeswell, Rob Dudumayo, Ntomboxolo Rametsi, Lesego Martinson, Neil Lipman, Marc Glynn, Judith R Sonnenberg, Pam BMC Public Health Research Article BACKGROUND: Traditional tuberculosis (TB) treatment outcome measures, such as cure rate, do not provide insight into the underlying reasons for missing clinical targets. We evaluated a TB Process-Based Performance Review (TB-PBPR) tool, developed to identify "missed opportunities" for timely and accurate diagnosis of TB. The tool enables performance assessment at the level of process and quality of care. METHODS: The TB-PBPR tool is a single-page structured flow-sheet that identifies 14 clinical actions (grouped into elicited symptoms, clinical examination and investigations). Medical records from selected deceased patients were reviewed at two South African mine hospitals (A = 56 cases; B = 26 cases), a South African teaching hospital (C = 20 cases) and a UK teaching hospital (D = 13 cases). RESULTS: In hospital A, where autopsy was routine, TB was missed in life in 52% (23/44) of cases and was wrongly attributed as the cause of death in 16% (18/110). Clinical omissions were identified at each hospital and at every stage of clinical management. For example, recording of chest symptoms was omitted in up to 39% of cases, sputum smear examination in up to 85% and chest radiograph in up to 38% of cases respectively. CONCLUSIONS: This study introduces the TB-PBPR tool as a novel method to review and evaluate clinical performance in TB management. We found that simple clinical actions were omitted in many cases. The tool, in conjunction with a manual describing best practice, is adaptable to a range of settings, is educational and enables detailed feedback within a TB programme. The TB-PBPR tool and manual are both freely available for general use. BioMed Central 2011-02-22 /pmc/articles/PMC3051909/ /pubmed/21342493 http://dx.doi.org/10.1186/1471-2458-11-127 Text en Copyright ©2011 Field et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Field, Nigel
Murray, Jill
Wong, Michelle L
Dowdeswell, Rob
Dudumayo, Ntomboxolo
Rametsi, Lesego
Martinson, Neil
Lipman, Marc
Glynn, Judith R
Sonnenberg, Pam
Missed opportunities in TB diagnosis: a TB Process-Based Performance Review tool to evaluate and improve clinical care
title Missed opportunities in TB diagnosis: a TB Process-Based Performance Review tool to evaluate and improve clinical care
title_full Missed opportunities in TB diagnosis: a TB Process-Based Performance Review tool to evaluate and improve clinical care
title_fullStr Missed opportunities in TB diagnosis: a TB Process-Based Performance Review tool to evaluate and improve clinical care
title_full_unstemmed Missed opportunities in TB diagnosis: a TB Process-Based Performance Review tool to evaluate and improve clinical care
title_short Missed opportunities in TB diagnosis: a TB Process-Based Performance Review tool to evaluate and improve clinical care
title_sort missed opportunities in tb diagnosis: a tb process-based performance review tool to evaluate and improve clinical care
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3051909/
https://www.ncbi.nlm.nih.gov/pubmed/21342493
http://dx.doi.org/10.1186/1471-2458-11-127
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