Hepatitis B Screening of At-Risk Immigrants Seen at Primary Care Clinics: A Quality Improvement Project

Peace N Eneh; Mohamed Mady; Mikayla A Schmidt; Eneyew Tilahun; Fatima Hassan; Jane W Njeru; Sarah J Crane; Rajeev Chaudhry; Lewis R Roberts

doi:10.1016/j.mayocpiqo.2021.04.002

Hepatitis B Screening of At-Risk Immigrants Seen at Primary Care Clinics: A Quality Improvement Project

Mayo Clin Proc Innov Qual Outcomes. 2021 May 27;5(3):635-644. doi: 10.1016/j.mayocpiqo.2021.04.002. eCollection 2021 Jun.

Authors

Peace N Eneh¹, Mohamed Mady¹, Mikayla A Schmidt¹, Eneyew Tilahun¹, Fatima Hassan¹, Jane W Njeru², Sarah J Crane², Rajeev Chaudhry², Lewis R Roberts¹

Affiliations

¹ Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
² Division of Community Internal Medicine, Mayo Clinic, Rochester, MN.

Abstract

Objective: To test an intervention to increase screening for hepatitis B (HBV) in at-risk immigrants in the primary care setting.

Patients and methods: From a Mayo Clinic primary care panel, we identified approximately 19,000 immigrant patients from 9 high-risk countries/ethnic groups with intermediate or high prevalences of chronic HBV. Eligible patients with no record of prior HBV testing scheduled for primary care visits within the study period spanning October 1, 2017, through October 31, 2018, were identified. During the intervention period, the primary health care professional was notified by email 1 week prior to each primary care visit and encouraged to discuss screening for HBV infection and order screening tests at the appointment. We assessed rates of HBV screening during control and intervention periods.

Results: We identified 597 patients in the control period and 212 patients in the intervention period who had not been screened previously for HBV. During the intervention period, 31.4% (58) of the 185 eligible patients were screened for HBV vs 7.2% (43) of the 597 eligible patients in the control period. Thus, the intervention resulted in a 4.3-fold increase in screening (P<.00001). Of the 101 patients screened in the at-risk population, 22 (21.8%) screened positive for prior exposure to HBV (hepatitis B core antibody-positive) and 6 (5.9%) for chronic HBV infection (hepatitis B surface antigen-positive).

Conclusion: Notifying primary care physicians of the high-risk status of immigrant patients substantially increased screening for HBV. Identifying patients with HBV is important for monitoring disease prevalence, preventing transmission, and initiating treatment and cancer surveillance, allowing earlier recognition and prevention of chronic hepatitis, disease reactivation, cirrhosis, and hepatocellular carcinoma.

Keywords: ACE, Advanced Cohort Explorer; CKS, Cohort Knowledge Solutions; HBV, hepatitis B virus; HBcAb, hepatitis B core antibody; HCC, hepatocellular carcinoma; PCP, primary health care professional; PDSA, Plan-Do-Study-Act; QI, quality improvement.

Abstract

Grants and funding