Tuberculosis (TB) Risk Assessment - Exploratory Tip Sheet
The percentage of members ages 12 months to 21 years (up to before their 21st birthday) who have been screened for latent tuberculosis infection (LTBI) risk factors by staff at the PCP office during the measurement year.
In 2021, the referral completion is an Exploratory Measure, and will not qualify for payment. Data will be available quarterly for providers to track their member’s compliance in 2021. The Alliance is reviewing this measure for consideration for payment in 2022. For additional information refer to the 2021 CBI Technical Specifications.
ICD-10 Code: Z11.1: “encounter for screening for respiratory tuberculosis.”
Currently being treated for LTBI or TB disease.
Approximately 30% of persons exposed to Mycobacterium tuberculosis (TB) will develop LTBI and, if untreated, approximately 5% to 10% of these persons will progress to active tuberculosis disease or reactivation of tuberculosis. Primary care clinicians can change the fate of those members infected with TB but never treated for it. There are 13 million persons estimated to be living with LTBI1. (https://jamanetwork.com/journals/jama/fullarticle/2547762)
The CDC and U.S. Preventive Services Task Force (USPSTF) recommend screening for LTBI in populations at increased risk. Risk for TB generally falls into two groups, first they are likely to be exposed to someone with active TB disease, or second, they themselves have health conditions that are associated with an increased risk of progression from LTBI to TB disease. Some of your patients may be at higher risk than others including:
- People who spend time in places where TB is more common (e.g. medical staff, homeless shelters, nursing homes, etc.)
- Patients from countries where TB disease is common, or those who have traveled to these areas (most countries in Latin America, the Caribbean, Africa, Asia, Eastern Europe, and Russia)
- Patients who have spent time with someone who has TB disease
Also, at risk are those with certain conditions:
- Patients that are immunosuppressed
- Patients diagnosed with Diabetes Mellitus
- Patients that received solid organ transplants
- Recent test convertors (defined as persons with baseline testing results who have an increase of 10 mm or more in the size of the Tuberculin Skin Test (TST) reaction within a 2-year period)
- Use the risk assessment tool for asymptomatic children to screen for risk for latent TB prior to testing. Recommended screening tool: https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/TBCB-CA-Pediatric-TB-Risk-Assessment.pdf
- Add flag to electronic health record to remind for annual screening.
- Identify foreign-born patients and screen them ahead of US born patients.
- Use interferon-gamma release assays (IGRAs) or the “blood test” for any TB testing needed with the exception that it should not be used for children less than two years old.
- Post this guide in your clinic’s staff work areas: https://tinyurl.com/yys8zohg
- Develop a nursing workflow for screening, testing and following up on patients with LTBI.
- Educate patients and clinic staff about TB with available handouts, tip sheets, guides and toolkits. The CDC has developed several educational resources posted to their website, including select materials that are free to order: https://www.cdc.gov/tb/publications/default.htm