Abstract
To measure the effect of an electronic health record (EHR) alert on chronic hepatitis B (CHB) screening among at-risk Asian and Pacific Islanders (API). API patients who had not yet completed hepatitis B surface antigen (HBsAg) testing were identified by a novel EHR-based population health tool. At-risk API patients in Cohort 1 (primarily privately insured) and Cohort 2 (includes Medicare and/or Medicaid) were randomized to alert activation in their electronic medical charts or not. In total, 8299 API were found to be deficient in HBsAg completion at baseline within our health system. In Cohort 1, 1542 patients and 1568 patients were randomized to the alert and control respectively. In Cohort 2, 2599 patients and 2590 patients were randomized to the alert and control respectively. For both cohorts combined, 389 HBsAg tests were completed in the alert group compared to 177 HBsAg tests in the control group (p < 0.0001; OR = 2.3; 95% CI 1.94–2.80), but there was no increased detection of HBsAg positivity from the alert (15 versus 13 respectively, p = 0.09; OR = 0.5; 95% CI 0.24–1.09). Our results demonstrate that personalized, automated electronic alerts increase screening for CHB, but more comprehensive measures are needed to detect HBsAg positive patients.NIH Trial Registry Number: NCT04240678.
Highlights
Background and significanceBased on the most recent analysis of National Health and Nutrition Examination Survey (NHANES), chronic hepatitis B (CHB) affects 847,000 persons in the United States, which included approximately 400,000 nonHispanic Asians
The Centers for Disease Control and Prevention (CDC), United States Preventive Services Task Force, and the American Association for Study of Liver Diseases have recommended screening all persons born in countries with CHB endemicity ≥ 2%
We found that the alert caused a more than twofold increase in completion of hepatitis B surface antigen (HBsAg) testing compared to controls after 1 year, but did not increase rates of HBsAg positive tests[9]
Summary
Based on the most recent analysis of National Health and Nutrition Examination Survey (NHANES), chronic hepatitis B (CHB) affects 847,000 persons in the United States, which included approximately 400,000 nonHispanic Asians. These Asians had a tenfold greater prevalence of CHB than the American general population[1]. The Centers for Disease Control and Prevention (CDC), United States Preventive Services Task Force, and the American Association for Study of Liver Diseases have recommended screening all persons born in countries with CHB endemicity ≥ 2% Despite these recommendations, screening rates for CHB remain low, which may be due in part to lack of physician awareness and knowledge about CHB g uidelines[5,6,7,8]
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