A Best Practice Alert for Identifying Hepatitis B–Infected Patients

Abstract

We developed and evaluated the Global Health Wizard Hepatitis B Best Practice Alert (BPA) to increase primary care provider adherence to evidence-based guidelines for hepatitis B virus (HBV) infection screening in non-U.S.born patients. We conducted a pilot study using nine clinics to test BPA effectiveness. Eligible patients were aged ³ 12 years, from a country of origin with ³ 2% HBV prevalence, had no electronic health record documentation of HBV screening, and were seen for primary care during July 2012-March 2013. The BPA triggered for > 4,500 patients and identified six previously unrecognized HBV-infected patients. The pilot project demonstrated BPA effectiveness and continued to be used at pilot clinics until 2018 and was expanded to additional clinics in 2019; 29 additional HBV-infected patients were identified. Although successful, BPA usage steadily decreased over time. Poor BPA usage limits the power to achieve the goal of improved population-based HBV screening.

Get2PrEP: An Electronic Medical Record Laboratory Comment Increased Safe Sex Counseling But Not Preexposure Prophylaxis Services at a Large Urban Academic Medical Center in Northern Manhattan

“…However, other electronic CDS tools, such as best practice alerts, have previously demonstrated mixed results. Clinical decision support tools have been shown to improve compliance with screening guidelines by increasing testing rates for hepatitis B and C and decreasing inappropriate testing for Clostridium difficile 23–25 . However, CDS tools have been less effective in reducing inappropriate antibiotic use in several cases 26,27 .…”

Cancer Screening in Refugees and Immigrants: A Global Perspective

“…57,58 Additionally, automated best practice alerts that trigger based on country of birth can improve screening for HBV, and implementation of a chronic disease registry for HBV may improve adherence to HBV care and HCC screening recommendations. 59 Hepatitis C. Although hepatitis C is a risk factor for hepatocellular carcinoma, there is little generalizable data on the epidemiology of HCV infection in refugee populations. Prevalence rates vary among refugee groups from very low (, 1%) to high (7-8%), and further research is needed to define HCV infection rates in refugees.…”

Clinical Decision Support Systems for Diagnosis in Primary Care: A Scoping Review

“…Twenty-six clinical studies (17 randomized control trials [RCTs] and nine non-RCTs) were included (Table 1). They comprised 10 studies on combined outcomes including malignancy prevention, vaccine uptake, and lifestyle prevention [26][27][28][29][30][31][32][33][34][35]; three studies on malignancy (one each on breast cancer, cervical cancer, and colorectal cancer) [36][37][38]; five studies on cardiovascular risk factors (one each on diabetes mellitus [DM], dyslipidemia [DLP], obesity, abdominal aortic aneurysm [AAA], and chronic kidney disease [CKD]) [39][40][41][42][43]; two studies on musculoskeletal diseases (one each on osteoporosis and function) [44,45]; three studies on infectious diseases (two on hepatitis B virus [HBV] and one on human immunodeficiency virus [HIV]) [46][47][48]; and others included one study on depression, one study on dementia, and one study on domestic violence [49][50][51]. Common chronic diseases were the main target, and none of the studies included common acute diseases or uncommon chronic diseases.…”

“…DeSilva et al [46] conducted a pilot study at nine clinics to screen for HBV infection in people born outside the United States. Eligible patients were aged ≥ 12 years and from countries with HBV infection rates of 2% or higher.…”