Tuberculosis in the veterans healthcare system: A six-year review and evaluation of programme effectiveness

G. A. Roselle, L. H. Danko, S. M. Kralovic, L. A. Simbartl, Kenneth W Kizer

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

The Department of Veterans Affairs operates a large, centrally administered health care system consisting of 173 hospitals and 4 free standing outpatient clinics nationwide with approximately 945115 hospital discharges, 24.2 million outpatient visits, and 2.86 million persons served annually over the time frame of the review. The purpose of the study was to define whether such a system could effect timely change in the incidence of tuberculosis (TB) using centralized programme planning and flexible field implementation. A retrospective review of the number of newly diagnosed cases of active TB treated at veterans health care facilities between 1 October 1990 and 30 September 1997 was determined by using a standardized annual case census. Intervention included implementation of the most current guidelines for the prevention of transmission of TB in the community and hospital setting, including administrative and engineering controls and a change in personal protective equipment. Centrally directed programme guidance, education, and funding were provided for field use in health care facilities of widely varying size and complexity. The numbers of total reported cases of TB decreased significantly (P < 0.001) throughout the veterans health care system (nationally and regionally), with the case rate decreasing at a rate significantly greater than that seen in the USA as a whole (P < 0.0001). TB associated with multi-drug resistance (isoniazid and rifampin) and HIV coinfection also significantly decreased over the study period. Therefore, a large, centrally administered health care system can effectively combat a re-emerging infectious disease and may also demonstrate a successful outcome greater than seen in other, perhaps less organized health care settings.

Original languageEnglish (US)
Pages (from-to)315-323
Number of pages9
JournalEpidemiology and Infection
Volume125
Issue number2
DOIs
StatePublished - 2000
Externally publishedYes

Fingerprint

Program Evaluation
Veterans
Tuberculosis
Delivery of Health Care
Veterans Health
Health Facilities
Ambulatory Care Facilities
Emerging Communicable Diseases
Community Hospital
Isoniazid
Multiple Drug Resistance
Censuses
Rifampin
Coinfection
Outpatients
HIV
Guidelines
Education
Incidence

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Immunology

Cite this

Tuberculosis in the veterans healthcare system : A six-year review and evaluation of programme effectiveness. / Roselle, G. A.; Danko, L. H.; Kralovic, S. M.; Simbartl, L. A.; Kizer, Kenneth W.

In: Epidemiology and Infection, Vol. 125, No. 2, 2000, p. 315-323.

Research output: Contribution to journalArticle

Roselle, G. A. ; Danko, L. H. ; Kralovic, S. M. ; Simbartl, L. A. ; Kizer, Kenneth W. / Tuberculosis in the veterans healthcare system : A six-year review and evaluation of programme effectiveness. In: Epidemiology and Infection. 2000 ; Vol. 125, No. 2. pp. 315-323.
@article{24282c71f11943668e16ddb669d6a784,
title = "Tuberculosis in the veterans healthcare system: A six-year review and evaluation of programme effectiveness",
abstract = "The Department of Veterans Affairs operates a large, centrally administered health care system consisting of 173 hospitals and 4 free standing outpatient clinics nationwide with approximately 945115 hospital discharges, 24.2 million outpatient visits, and 2.86 million persons served annually over the time frame of the review. The purpose of the study was to define whether such a system could effect timely change in the incidence of tuberculosis (TB) using centralized programme planning and flexible field implementation. A retrospective review of the number of newly diagnosed cases of active TB treated at veterans health care facilities between 1 October 1990 and 30 September 1997 was determined by using a standardized annual case census. Intervention included implementation of the most current guidelines for the prevention of transmission of TB in the community and hospital setting, including administrative and engineering controls and a change in personal protective equipment. Centrally directed programme guidance, education, and funding were provided for field use in health care facilities of widely varying size and complexity. The numbers of total reported cases of TB decreased significantly (P < 0.001) throughout the veterans health care system (nationally and regionally), with the case rate decreasing at a rate significantly greater than that seen in the USA as a whole (P < 0.0001). TB associated with multi-drug resistance (isoniazid and rifampin) and HIV coinfection also significantly decreased over the study period. Therefore, a large, centrally administered health care system can effectively combat a re-emerging infectious disease and may also demonstrate a successful outcome greater than seen in other, perhaps less organized health care settings.",
author = "Roselle, {G. A.} and Danko, {L. H.} and Kralovic, {S. M.} and Simbartl, {L. A.} and Kizer, {Kenneth W}",
year = "2000",
doi = "10.1017/S0950268899004409",
language = "English (US)",
volume = "125",
pages = "315--323",
journal = "Epidemiology and Infection",
issn = "0950-2688",
publisher = "Cambridge University Press",
number = "2",

}

TY - JOUR

T1 - Tuberculosis in the veterans healthcare system

T2 - A six-year review and evaluation of programme effectiveness

AU - Roselle, G. A.

AU - Danko, L. H.

AU - Kralovic, S. M.

AU - Simbartl, L. A.

AU - Kizer, Kenneth W

PY - 2000

Y1 - 2000

N2 - The Department of Veterans Affairs operates a large, centrally administered health care system consisting of 173 hospitals and 4 free standing outpatient clinics nationwide with approximately 945115 hospital discharges, 24.2 million outpatient visits, and 2.86 million persons served annually over the time frame of the review. The purpose of the study was to define whether such a system could effect timely change in the incidence of tuberculosis (TB) using centralized programme planning and flexible field implementation. A retrospective review of the number of newly diagnosed cases of active TB treated at veterans health care facilities between 1 October 1990 and 30 September 1997 was determined by using a standardized annual case census. Intervention included implementation of the most current guidelines for the prevention of transmission of TB in the community and hospital setting, including administrative and engineering controls and a change in personal protective equipment. Centrally directed programme guidance, education, and funding were provided for field use in health care facilities of widely varying size and complexity. The numbers of total reported cases of TB decreased significantly (P < 0.001) throughout the veterans health care system (nationally and regionally), with the case rate decreasing at a rate significantly greater than that seen in the USA as a whole (P < 0.0001). TB associated with multi-drug resistance (isoniazid and rifampin) and HIV coinfection also significantly decreased over the study period. Therefore, a large, centrally administered health care system can effectively combat a re-emerging infectious disease and may also demonstrate a successful outcome greater than seen in other, perhaps less organized health care settings.

AB - The Department of Veterans Affairs operates a large, centrally administered health care system consisting of 173 hospitals and 4 free standing outpatient clinics nationwide with approximately 945115 hospital discharges, 24.2 million outpatient visits, and 2.86 million persons served annually over the time frame of the review. The purpose of the study was to define whether such a system could effect timely change in the incidence of tuberculosis (TB) using centralized programme planning and flexible field implementation. A retrospective review of the number of newly diagnosed cases of active TB treated at veterans health care facilities between 1 October 1990 and 30 September 1997 was determined by using a standardized annual case census. Intervention included implementation of the most current guidelines for the prevention of transmission of TB in the community and hospital setting, including administrative and engineering controls and a change in personal protective equipment. Centrally directed programme guidance, education, and funding were provided for field use in health care facilities of widely varying size and complexity. The numbers of total reported cases of TB decreased significantly (P < 0.001) throughout the veterans health care system (nationally and regionally), with the case rate decreasing at a rate significantly greater than that seen in the USA as a whole (P < 0.0001). TB associated with multi-drug resistance (isoniazid and rifampin) and HIV coinfection also significantly decreased over the study period. Therefore, a large, centrally administered health care system can effectively combat a re-emerging infectious disease and may also demonstrate a successful outcome greater than seen in other, perhaps less organized health care settings.

UR - http://www.scopus.com/inward/record.url?scp=0033671106&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033671106&partnerID=8YFLogxK

U2 - 10.1017/S0950268899004409

DO - 10.1017/S0950268899004409

M3 - Article

C2 - 11117955

AN - SCOPUS:0033671106

VL - 125

SP - 315

EP - 323

JO - Epidemiology and Infection

JF - Epidemiology and Infection

SN - 0950-2688

IS - 2

ER -