Encouraging a
Culture of Improvement
Analysis of Panel Site Data
Dr Dominik Zenner
Objectives
1.To provide a general overview of UKTB screening processes
and increase knowledge how data is supporting QA processes
2.To improve specific understanding of data requirements and
collection processes for UKTB screening
3.To gain practical knowledge, how insights from clinic data and
information will drive improvements in screening and healthcare
delivery
Why is it important?
•We therefore intend to expand this [pre-entry screening] programme to …
visa applicants applying to stay in the UK for longer than six months from the
over 80 countries with a high incidence of TB, beginning the roll-out this
summer …. On-entry x-ray checks at Heathrow and Gatwick airports will be
phased out.
•We will … explore ways to improve the sharing of information between the
UK Border Agency and the HPA about individuals coming to live in the UK for
more than 6 months from high incidence countries. This will complement the
systems that are already in place at a local level for connecting individuals
with healthcare services.
Damien Green (Minister of State for Immigration)
Quality assurance and performance
management
Component 1: Data and
epidemiological analysis
Home Office UK V&I
Performance
management
Component 2:
Outreach
clinic management
Component 3: Teleradiology
Location of pre-entry screening sites globally
(includes IOM and non-IOM sites).
What we monitor
… basically the implementation of the UKTIs
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/245009/UK_tuberculosis_techni
cal_instructions.pdf
UKTIs simplified
Start
Process
Result
CXR-/Sx -
Clearance
CXR
Sx check
CultureSx+ and/or CXR+
Late clearance
culture pending
Culture +
Treatment
Applicants screened 2005-2015
In total, 1,217,842 applicants were screened
Of which 256,115 were screened in 2015
300,000
250,000
Number of applicants
200,000
150,000
100,000
50,000
0
2005
2006
2007
2008
2009
2010
2011
Africa
Caribbean
Europe & CIS
Middle East
South & Central America
South East Asia
2012
2013
2014
Indian Sub-continent
2015
Chest X- Rays
Sputum collection and processing
TB rate in relation to culture confirmation
*
300
250
80
200
60
150
40
100
20
50
0
TB detection rate (per 100,000) with 95% CI
Sputum cultures as a % of smears
100
0
2006
2007
2008
2009
2010
2011
Screening year
Culture as % of smears
2012
2013
2014
2015
TB rate
* Rate may increase as some samples are pending
TB detection yield (per 100,000) and the proportion of cultures amongst all samples (‘smears’), amongst all
countries with IOM providers (n=40) by year of screening
160
100
80
120
60
80
40
40
20
0
0
2007
2008
2009
2010
2011
Positive cultures
2012
% DST
2013
2014
2015
% drug susceptibility tests done
Number of positive sputum cultures
Culture confirmation and DST over the years… (IOM only)
Drug resistance 2005-15 (IOM only)
XDR
MDR
INH resistant
Monoresistant to a drug other
than INH
Pansusceptible
Poly drug resistant but not MDR
or XDR
RIF monoresistance
How we monitor
Data returns (all)
Table 1: TB data flowchart: collection, checking, matching, analysis and reporting
Monthly data transfer
via Cyber-Ark
IOM
clinics
TB Screening Unit
PHE, Colindale
Non-IOM
clinics
Monthly data transfer
via gsi email
Data checking,
cleaning & matching
Feedback
every quarter
PHE
Home office
Template
for routine
Monthly
reports
Data returns (non-IOM)
Updates on sputum cultures from previous month (information passed on via post)
CLINICS
Clinical data from
month
Follow-up if did not receive
data from certain clinic
POSTS
Personal details for
each applicant from
month
[email protected]
All clinical data into one sheet with all
clinic names included from month
Data returns (the small print…)
Since 1 January 2015 data returns mandatory requirement
Clinic sends TB reporting excel sheet filled in completely back to the Post monthly,
which the post compiles into one sheet ensuring that clinic names are complete
Post completes personal details from visa applicants from the same month
Post sends one sheet of clinical data from all clinics and one sheet of
corresponding personal data to the [email protected] once monthly
All this will be easier once global web-based system in place
20
How else do we use the data?
The annual pre-entry screening report
https://www.gov.uk/government/publications/tuberculosis-pre-entry-screening-in-the-uk
Number of pulmonary TB cases diagnosed by pre-entry screening and
identified within one year of UK entry from the high TB incidence
countries,
2006
to
2014*
600
Number of pulmonary TB cases
500
400
300
200
100
0
2006
2007
2008
2009
2010
2011
Year of screening/entry to UK
TB cases diagnosed by pre-entry screening
2012
2013
TB cases identified in the UK
2014
2015**
IRHWG information sharing
• Sharing of
•
•
•
•
QA data and information
Clinic visits, findings and concerns
Updates on clinics and personnel
Educational initiatives
• There is a much greater vision
• shared quality assurance framework
• Shared QA tools
How can you use the data?
Set
standard
Measure
practice
Challenge
practice
Compare
with
standards
“The difference between what we do and what we are
capable of doing would suffice to solve most of the world’s
problem.”
M.K . Ghandi
Small discussion groups
1.What types of information and data are you interested in
locally? Why?
2.Suggest some ways how you could use data to improve
local practice
3.How could you use these data to obtain more resources?
Improve facilities?
Summary
• The UK pre-entry screening programme has been fully rolled out
since April 2014. Its aims are
• To prevent TB cases in the receiving country and protect public health
• To provide savings for the receiving countries’ health system
• Robust data collection is mandatory and used to
• Ensure the integrity and quality of the system
• Demonstrate effectiveness and cost-effectiveness (thus sustainability)
• Information and data can be used locally as evidence to
• Assure system integrity and quality
• Promote and encourage a culture of excellence
• Successfully argue business cases
Thank you
• Please check out our website
• https://www.gov.uk/tuberculosis-screening