Improving compliance with tuberculin skin test interpretation in children

Objective  To evaluate the effect of a quality improvement initiative which utilized educational interventions combined with a phone follow-up program on the rate of return for tuberculin skin test (TST) interpretation.

Design Before and after trial with analysis of practice records for all TSTs placed.

Setting/Sample  The study was conducted in a resident and attending primary care practice in an urban children's hospital. All children (n = 1315) who had TSTs placed during August and October of 1995 and August and October of 1996 were included in the study.

Intervention  Medical staff were re-educated regarding TST screening. Patients families were given written information about tuberculosis. Physicians and nursing staff discussed TST screening with the patients' families prior to TST placement. All patients received a series of three reminder telephone calls on three consecutive days to remind them to return for TST interpretation followed by a letter if necessary. The following data were collected: date of birth, age, zip code, type of provider, transit time from the hospital, type of health insurance, number of telephone calls made, and return status for TST interpretation. Return rates were compared pre- and post-intervention.

Results  A total of 1315 TSTs were placed during the pre- (n = 611) and post-(n = 704) intervention periods. Return rates increased from 6.2 to 61.5%. Attendings' patients and those with private insurance were more likely to return. There was no relationship to season, age or distance from the practice.

Conclusions  Targeted screening programs utilizing more effective methods for TST interpretation should be considered.