Abstract
Background/Aim: Hepatitis B virus (HBV) infection is the principal risk factor for hepatocellular carcinoma (HCC) among Asian Americans. Earlier detection of HBV may be life-saving; however, rates of HBV screening in Asian Americans remain unusually low. The purpose of this study was to test the feasibility of an electronic health record (EHR)-based provider intervention to increase HBV screening in Asian Americans within an academic health system.
Methods: Entry criteria were: outpatients, ages 18–64, with Chinese or Vietnamese surnames scheduled for appointment in a primary care clinic with no record of an HBsAg test, and who were not pregnant. Providers at any of 15 primary care clinics were randomly assigned to the control or intervention arm. Providers in the intervention arm received a standardized EHR message 24 hours prior to the appointment which referred to the patient as a candidate for HBV screening and included recommendations for testing. Providers in the control group (“usual care”) received no message. Outcome measures to compare differences between intervention and control arms were the proportion of patients with (1) HBsAg tests ordered by providers; (2) HBsAg tests completed by patients. Results from patients who were tested for HBV were reported.
Results: One hundred thirty patients meeting entry criteria were seen by 63 providers during the 3 month study period. Sixty seven patients were seen by 31 providers who were randomized to the intervention arm and 63 patients were seen by 32 providers randomized to the control arm. Patient demographics did not differ significantly between groups. The mean number of patients per provider was 2.09 and 2.03 in the intervention and control groups, respectively. For outcome (1), providers ordered HBsAg tests for 36/67 (53.7%) intervention patients versus 1/67 (1.6%) control patients (p < 0.001). For outcome (2), 29/36 (80.6%) intervention patients completed their HBsAg test versus 0/1 control group patient. Four (13.7%) of 29 patients tested positive for HBsAg, 12 (41.4%) were reactive for anti-HBs and 13 (44.8%) were HBV-naïve. Patient demographics (gender, ethnicity, and mean age) did not significantly differ between patients with and without an HBsAg test ordered. Providers were more likely to order the HBV screening if the patients came in for preventive care rather than patients who had a specific medical issue (p = 0.040). There were no significant differences in provider characteristics (gender, ethnicity or medical specialty) between those that ordered the HBsAg test and those that did not.
Conclusions: Electronic prompting resulted in significantly greater rates of HBsAg tests ordered by providers (p < 0.001) and markedly greater rates of HBsAg tests completed by patients than “usual care.” As a result, earlier detection of patients who tested HBsAg positive occurred and represents a promising intervention to significantly increase HBV screening that could reduce HBV-induced HCC disparities.
Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B99.
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