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Developing and Using Performance Measures Based on Surveillance Data for Program Improvement in Tuberculosis Control

Ehman, Melissa MPH; Shaw, Tambi MPH; Cass, Anne MPH; Lawton, Elizabeth MHS; Westenhouse, Janice MPH; Young, Jan RN, MSN; Royce, Sarah MD, MPH; Barry, Pennan MD, MPH

Journal of Public Health Management and Practice: September/October 2013 - Volume 19 - Issue 5 - p E29–E37
doi: 10.1097/PHH.0b013e3182751d6f
Original Articles

California state and local tuberculosis (TB) programs used a systematic process to develop a set of indicators to measure and improve program performance in controlling TB. These indicators were the basis for a quality improvement process known as the TB Indicators Project. Indicators were derived from guidelines and legal mandates for clinical, case management, and surveillance standards and were assessed using established criteria. The indicators were calculated using existing surveillance data. The indicator set was field tested by local programs with high TB morbidity and subsequently revised. Collaboration with key stakeholders at all stages was crucial to developing useful and accepted indicators. Data accessibility was a critical requirement for indicator implementation. Indicators most frequently targeted for performance improvement were those perceived to be amenable to intervention. Indicators based on surveillance data can complement other public health program improvement efforts by identifying program gaps and successes and monitoring performance trends.

This study aims at creating and assessing the use of a set of indicators for measuring tuberculosis prevention and control performance.

Surveillance and Epidemiology Section (Ms Ehman), Outbreak Prevention and Control Section (Ms Shaw), Program Development Section (Ms Cass), Surveillance and Epidemiology Section (Ms Westenhouse), Program Development Section (Ms Young), and Surveillance and Epidemiology Section (Dr Barry), Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, and Department of Epidemiology and Biostatistics, University of California, San Francisco (Ms Ehman); Epidemiology Assessment and Program Development, Maternal, Child and Adolescent Health Program, Center for Family Health, California Department of Public Health, Sacramento (Ms Lawton); and Global Health Sciences, University of California, San Francisco (Dr Royce).

Correspondence: Melissa Ehman, MPH, California Department of Public Health, 850 Marina Bay Pkwy, Bldg P, 2nd Floor, Richmond, CA 94804 (

The authors thank local health department staff participating in TIP; Alex Golden for manuscript preparation; and Dr Jennifer Flood, Dr Julie Higashi, and Michael Carson for manuscript review.

Disclosure: The authors declare no conflicts of interest and no funding.

© 2013 Lippincott Williams & Wilkins, Inc.