Field N., Murray J., Wong M.L., Dowdeswell R., Dudumayo N., Rametsi L., Martinson N., Lipman M., Glynn J.R., Sonnenberg P.
Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, London, United Kingdom; National Institute for Occupational Health, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Division of Pulmonology, Department of Medicine, Chris Hani Baragwanath Hospital, Johannesburg, South Africa; Rustenburg Platinum Mines, Anglo Platinum, Rustenburg, South Africa; Lonmin PLC, Rustenburg, South Africa; Perinatal HIV Research Unit, University of the Witwatersrand, South Africa; Johns Hopkins University Center for TB Research, Baltimore, United States; Respiratory Medicine, Royal Free Hospital, London, United Kingdom; Infectious Disease Epidemiology Unit, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
Field, N., Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, London, United Kingdom; Murray, J., National Institute for Occupational Health, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Wong, M.L., Division of Pulmonology, Department of Medicine, Chris Hani Baragwanath Hospital, Johannesburg, South Africa; Dowdeswell, R., Rustenburg Platinum Mines, Anglo Platinum, Rustenburg, South Africa; Dudumayo, N., Lonmin PLC, Rustenburg, South Africa; Rametsi, L., Rustenburg Platinum Mines, Anglo Platinum, Rustenburg, South Africa; Martinson, N., Perinatal HIV Research Unit, University of the Witwatersrand, South Africa, Johns Hopkins University Center for TB Research, Baltimore, United States; Lipman, M., Respiratory Medicine, Royal Free Hospital, London, United Kingdom; Glynn, J.R., Infectious Disease Epidemiology Unit, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; Sonnenberg, P., Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, London, United Kingdom
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. © 2011 Field et al; licensee BioMed Central Ltd.