Chronic hepatitis B virus screening prior to rituximab: A quality improvement project.

Abstract

199 Background: Patients’ with chronic hepatitis B (HBV) are at risk for HBV reactivation and liver failure with initiation of rituximab therapy. HBV testing prior to rituximab for patients with non-Hodgkin lymphoma was a quality measure for the American Society of Clinical Oncology’s Quality Oncology Practice Initiative in Spring 2011. Methods: We assessed the pre-intervention HBV screening rate retrospectively from July 2009 to July 2011. Patient demographics, pathology, regimen, and prescriber were abstracted from the electronic medical record. Screening was complete if serum HBVsurface antigen was checked within 3 months prior to rituximab. A quality improvement (QI) intervention was initiated and all prescribers were informed of the screening rate in December 2011. Post-intervention, patients who received rituximab from January 2012 to July 2012 were identified and the same data was abstracted. HBV screening rates across categories pre and post-intervention were analyzed with Fisher’s exact test and multivariate logistic regression analysis. Results: A total of 146 patients (127 pre-intervention, 19 post-intervention) were included. There were more male and rituximab combination therapy in the post-intervention group. The HBV screening rate increased from 59% to 90% (p<0.01) after our QI project. In univariate analysis, factors associated with HBV screening were (1) prior treatment with rituximab (no: 72% vs. yes: 46%, p<0.01), (2) treatment regimen (rituximab alone: 68% vs. combination: 42%, <0.01) and (3) prescriber (full time: 69% vs. part time: 7%, <0.01) In multivariate logistic regression analysis, the odds of HBV screening increased 4.8 times in the post-intervention group compared to pre-intervention group although this was statistically not significant (p=0.07). Prior rituximab (Odds Ratio (OR) 0.4, 95%CI 0.2-0.9), combination regimen (OR 3.2, 95% CI 1.5-7.2), and full-time prescriber (OR 25.1, 95% CI 2.8-255.4) were statistically significant for HBV screening. Conclusions: The HBV screening rate improved after QI intervention although statistically insignificant in multivariate analysis. We identified characteristics associated with low screening rates which will guide future QI strategy.