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Background Patients with TB have diverse and often challenging clinical and social needs that may hamper successful treatment outcomes. Understanding the need for additional support during treatment (enhanced case management, or ECM) is important for workforce capacity planning. North West England TB Cohort Audit (TBCA) has introduced a 4-level ECM classification system (ECM 0–3) to quantify the need for ECM in the region. This study describes the data from the first 2 years of ECM classification. Methods Data collected between April 2013 and July 2015 were used to analyse the proportions of patients allocated to each ECM level and the prevalence of social and clinical factors indicating need for ECM. Single variable and multivariable logistic regression models were constructed to examine the association between ECM level and treatment outcome. Results Of 1714 notified cases 99.8% were assigned an ECM level: 31% ECM1, 19% ECM2 and 14% ECM3. The most common factors indicating need for ECM were language barriers (20.3%) and clinical complexity (16.9%). 1342/1493 (89.9%) of drug-sensitive, non-CNS cases completed treatment within 12 months. Patients in ECM2 and 3 were less likely to complete treatment at 12 months than patients in ECM0 (adjusted OR 0.47 [95% CI 0.27–0.84] and 0.23 [0.13–0.41] respectively). Conclusions Use of TBCA to quantify different levels of need for ECM is feasible and has demonstrated that social and clinical complexity is common in the region. Results will inform regional workforce planning and assist development of innovative methods to improve treatment outcomes in these vulnerable groups. Electronic supplementary material The online version of this article (10.1186/s12889-017-4892-5) contains supplementary material, which is available to authorized users.

This research was supported by Public Health England and the Centre for Applied Health Research and Delivery, Liverpool School of Tropical Medicine (LSTM). Objectives. 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. Design. 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. Analysis. 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. Publisher PDF

Introduction and objectives Tuberculosis cohort audit (TBCA) was introduced across the North West in 2012 as recommended by NICE. The approach taken and the outcome measures of the 1,515 TB cases reviewed are presented in a companion abstract. TBCA over a large geographical area has not undergone formal qualitative evaluation in the UK. We conducted a qualitative evaluation to explore perceptions about implementation and impact of TBCA in the North West. Methods One researcher conducted face to face, semi-structured, recorded interviews between 06/01/14 and14/03/14 with 26 purposively sampled respondents from three groups involved in TBCA: (a) TB nurse specialists; (b) Consultant physicians; (c) Public health practitioners. Transcripts were analysed descriptively and thematically using the Framework Method. Themes were triangulated with eight key informants from the TBCA Steering Group. Results Four themes were identified: 1. Preconceptions: Participants were optimistic about the potential of audit to improve practice but worried about time demands and scrutiny from colleagues. 2. Experience of TBCA: All groups felt engaged and appreciated TBCA. Nurses requested more engagement from consultant colleagues. Fears about time demands and scrutiny were not realised. 3. Changes as a result of TBCA : Improvements to practice were identified including harmonisation of approaches, increased HIV testing, and improved documentation. TBCA was felt to provide peer support and learning through discussion and a no-blame atmosphere. 4. Looking Ahead: Suggestionsfor further improvement were captured, such as more in-depth discussion around complex cases. If TBCA were to be discontinued (e.g. because of funding contraints), adverse consequences were predicted: e.g. disappointed and disenfranchised professionals, financial and patient harms. Conclusions Overall, TBCA in the North West has led to the development of a unique and valuable community of practice. The interchange of experience and ideas across a large number of teams and professionals has enhanced mutual respect between different roles and a shared sense of purpose. TBCA is appreciated by health professionals who participate. Continuing success will require increased engagement of consultant physicians and public health practitioners, a secure an ongoing funding stream and establishment of reporting mechanisms within the new commissioning structures.