Having Someone in Their Corner Helps TB Patients Negotiate System
From 1994 to 1997, Bellevue Hospital, New York, formed a coalition with five community-based organizations to screen for tuberculosis infection and disease in the community and provide appropriate patient management services.
The coalition agreed on a plan to share responsibility for screening and medical supervision among Bellevue and the community-based organizations.
The project was part of the Robert Wood Johnson Foundation's (RWJF) national program Old Disease, New Challenge: Tuberculosis in the 1990s.
The coalition hired five community liaison workers who played a critical role in the project. Each worker was assigned to one of the community-based organizations. Their role was to navigate, on behalf of the patients, and negotiate systems both at agencies and at Bellevue.
- Bellevue Hospital opened three satellite clinics at community-based organizations, and hopes to open more in the next few years.
- Community-based organizations offered food coupons were offered as an incentive for having a chest x-ray after having a positive skin test, and client response was enthusiastic.
- In 1995, the program was selected for "Honorable Mention" in the U.S. Department of Health & Human Services, Bureau of Primary Care Models that Work competition.
RWJF supported the project with a grant of $1,155,000 between January 1994 and September 1997.
Bellevue Hospital's main catchment area includes such at-risk populations as the homeless, substance abusers, the mentally ill, and persons living with HIV infection. These are individuals whose psychosocial and cultural needs make completion of a full course of TB treatment problematic.
To increase the number of treatment completions, Bellevue formed a coalition with five community-based organizations (CBOs) Lower East Side Service Center, The Educational Alliance, BRC Human Resources Corporation, Housing Works, and The Community Health Project which had established records of serving the targeted population. The coalition agreed on a plan to share responsibility for screening and medical supervision among Bellevue and the CBOs.
The main objective of the project is to screen for tuberculosis infection and disease in the community and provide appropriate patient management services. Two secondary objectives are to:
- Provide culturally sensitive community-based TB education and training for CBO staff, clients, and the larger community.
- Reduce inpatient stays for patients with tuberculosis through improved discharge planning, using the network of housing and therapeutic services provided by the CBOs.
The coalition hired five community liaison workers (CLWs) who played a critical role in the project. Each CLW was assigned to one of the CBOs. Their role was to navigate, on behalf of the patients, and negotiate systems both at the agencies and at Bellevue. Fully credentialed by Bellevue and the CBOs, the CLWs have become the bridge between the community and the hospital. The direct intervention of CLWs and the participating CBOs helps to ensure that patients keep appointments, complete medical assessments, and comply with treatment plans.
In addition to providing CLWs, the coalition offers community education in four languages. Discussions focus on the importance of early recognition of the disease, the efficacy of preventive medication, confidentiality of TB treatment, and the connection between HIV and TB.
- Although the decrease in the number of tuberculosis cases suggests that the epidemic is leveling off, there is an increase as of 1997 in the number of people who have positive TB skin tests, but have not yet developed the disease.
- Bellevue Hospital has opened three satellite clinics at CBOs, and hopes to open more in the next few years.
- Results of a questionnaire used at the beginning and end of community education sessions indicate that certain groups are quite knowledgeable about TB, especially those clients with a history of incarceration. However, there is still much confusion as to how TB is spread, and the differences between TB infection and disease.
- Food coupons were offered by CBOs as an incentive for having a chest x-ray after having a positive skin test. Client response was enthusiastic.
In 1995, the program was selected for "Honorable Mention" in the US Department of Health & Human Services, Bureau of Primary Care Models that Work competition.
AFTER THE GRANT
The coalition plans to expand the array of social services being offered to their clients. It also hopes to offer TB screening services to CBOs outside the five-CBO network and to new immigrant groups. Nineteen CBOs outside the original five have approached the coalition and expressed interest in participating in the project.
GRANT DETAILS & CONTACT INFORMATION
Shared Responsibility Program for TB Casefinding and Treatment in New York City
New York City Health and Hospitals Corporation (New York, NY)
Dates: January 1994 to September 1997
Project Director: Neil Schluger, M.D.
(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)
Schluger NW, Huberman R, Wolinsky N, Dooley R, Rom WN, and Holzman RS. "Tuberculosis Infection and Disease Among Persons Seeking Social Services in New York City." International Journal of Tuberculosis and Lung Disease, 1(1): 3137, 1997. Abstract available online.
Report prepared by: Marie P. Lyons
Reviewed by: Marian Bass
Program Officer: Marilyn Aguirre-Molina
Evaluation Program Officer: James Knickman