The resurgence of tuberculosis has had a marked impact upon the Emory University School of Medicine community and Grady Memorial Hospital (GMH), a major teaching affiliate. GMH provides care to a large number of indigent minority patients with and at risk for tuberculosis. Currently, Atlanta has the highest rate of TB in the U.S. We propose to establish the Emory Tuberculosis Education and Control Program which will take advantage of a number of unique resources in our area (Emory University School of Medicine (EUSM) and School of Public Health, the Emory AIDS Training Network (EATN), GMH, the Centers for Disease Control and Prevention (CDC), Georgia Institute of Technology) in developing a model program for education, applied research, and TB control to help reduce the rate of TB in metropolitan Atlanta and the state of Georgia. Our first objective is to implement a coordinated competency based program of instruction for medical students and house staff in the principles and practice of preventing, managing, and controlling TB. Our curriculum expansion will be based on Knowles' principles of androgogy. Design, implementation, and evaluation will follow Green and Kreuter's PRECEDE-PROCEED analysis for health educational activities. Included in our model program will be a computer based learning component; the introduction of a problem based learning module on TB; summer research projects for medical students in the control of TB, applied research, or basic research. A second major aim of our program is to increase awareness and improve the knowledge base of community physicians. This effort will be done in collaboration with other groups such as the EATN and the American Lung Association through conferences, symposia, and a mini-residency program. We also plan to develop A Clinician's Guide to Tuberculosis in Georgia that can serve as a primary reference for practicing physicians. Applied research in the control and prevention of TB, both in the hospital and community is the third major objective of our program. Study of the efficacy of control measures to prevent nosocomial transmission of TB will be an important focus. We also plan a major expansion of screening and prevention efforts. Our fourth objective is to reduce the incidence of tuberculosis in Atlanta. This will require efforts to enhance communication and coordination of TB control activities with local and state health departments; EUSM and GMH; Morehouse School of Medicine; and the Division of TB Elimination at CDC. This will be accomplished in part by the establishment of a computerized network between these different groups that have responsibility for the management and care of TB patients. The establishment of a computerized network/TB database which will allow sharing of information between medical providers and the ability to track patients through the health care system should lead to improved surveillance and control of TB in our community and state. Implementation and evaluation of an intensive education program for TB patients at GMH, including one-to-one counseling and low-literacy teaching aids will also be a component of this objective.
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