UC Davis School of Medicine, Division of Gastroenterology and Hepatology, Sacramento, California.
Division of Biostatistics, Department of Public Health Sciences, School of Medicine, University of California, Davis.
Cancer Epidemiol Biomarkers Prev. 2018 Nov;27(11):1352-1357. doi: 10.1158/1055-9965.EPI-18-0448. Epub 2018 Aug 8.
Implementation of screening recommendations for chronic hepatitis B (CHB) among foreign-born persons at risk has been sub-optimal. The use of alerts and reminders in the electronic health record (EHR) has led to increased screening for other common conditions. The aim of our study was to measure the effectiveness of an EHR alert on the implementation of hepatitis B surface antigen (HBsAg) screening of foreign-born Asian and Pacific Islander (API) patients. We used a novel technique to identify API patients by self-identified ethnicity, surname, country of origin, and language preference, and who had no record of CHB screening with HBsAg within the EHR. Patients with Medicare and/or Medicaid insurance were excluded due to lack of coverage for routine HBsAg screening at the time of this study. At-risk API patients were randomized to alert activation in their EHR or not (control). A total of 2,987 patients met inclusion criteria and were randomized to the alert ( = 1,484) or control group ( = 1,503). In the alert group, 119 patients were tested for HBsAg, compared with 48 in the control group (odds ratio, 2.64; 95% confidence interval, 1.88-3.73; < 0.001). In the alert group, 4 of 119 (3.4%) tested HBsAg-positive compared with 5 of 48 (10.4%) in the control group ( = 0.12). An EHR alert significantly increased HBsAg testing among foreign-born APIs. Utilization of EHR alerts has the potential to improve implementation of hepatitis B-screening guidelines.
实施针对有风险的外国出生人群的慢性乙型肝炎（CHB）筛查建议一直不尽如人意。电子健康记录（EHR）中的警报和提醒已导致对其他常见疾病的筛查增加。我们研究的目的是衡量 EHR 警报对乙型肝炎表面抗原（HBsAg）筛查外国出生的亚洲和太平洋岛民（API）患者的实施效果。我们使用一种新的技术通过自我识别的族裔、姓氏、原籍国和语言偏好来识别 API 患者，并且他们在 EHR 中没有 CHB 筛查的 HBsAg 记录。由于在这项研究期间医疗保险和/或医疗补助保险患者缺乏常规 HBsAg 筛查的覆盖范围，因此排除了有 Medicare 和/或 Medicaid 保险的患者。有风险的 API 患者被随机分配到 EHR 中的警报激活或不激活（对照）。共有 2987 名患者符合纳入标准，并随机分配到警报（=1484）或对照组（=1503）。在警报组中，有 119 名患者接受了 HBsAg 检测，而对照组中只有 48 名（比值比，2.64；95%置信区间，1.88-3.73；<0.001）。在警报组中，119 名检测 HBsAg 的患者中有 4 名（3.4%）呈 HBsAg 阳性，而对照组中 48 名中有 5 名（10.4%）（=0.12）。EHR 警报显著增加了外国出生 API 人群的 HBsAg 检测。利用 EHR 警报有可能改善乙型肝炎筛查指南的实施。
