The Employee Fast Track Study:
We designed a study to examine factors associated with treatment
initiation and completion among health care workers at Harlem Hospital.
The study identified barriers including prolonged waiting times,
lengthy assessments by multiple providers, lack of reminder/recall
systems, and inconsistent provider decisions about indications for
LTBI treatment. A multi-disciplinary group consisting of the clinic
manager, providers, and health educators developed a program which
includes a streamlined visit process and evaluation criteria, specialized
forms for patients and providers, an interactive database for patient
information, color-coded charts, and a computerized reminder/recall
system. Significant results were achieved: Initiation rates increased
from 62% to 87%, and completion rates increased from 12% to 85%.
Gender, race, foreign birth and BCG status were not significantly
associated with initiation or completion of LTBI treatment. Physicians
and nurses were found to be less likely than other hospital employees
to initiate treatment for LTBI. Older health care workers were more
likely to complete treatment for LTBI.