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Development of a Hepatitis B Virus Reporter System to Monitor the Early Stages of the Replication Cycle
Published on: February 1, 2017
Improving Care for Patients with Chronic Hepatitis B via Establishment of a Disease Registry
Malini B DeSilva1,2, Ann Settgast1,3,4,2, Ella Chrenka1
1HealthPartners Institute, Bloomington, Minnesota.
Insights
A chronic hepatitis B (CHB) registry improved patient care by standardizing management and increasing laboratory testing and cancer screening. This intervention enhanced adherence to CHB guidelines.
Area of Science:
- Hepatology
- Public Health
- Clinical Informatics
Background:
- Clinician adherence to chronic hepatitis B virus (CHB) management guidelines in the U.S. is suboptimal.
- Effective strategies are needed to improve CHB patient care and outcomes.
Purpose of the Study:
- To evaluate the impact of a CHB registry on improving CHB management.
- To assess whether a registry-based outreach program enhances patient adherence to recommended laboratory testing and hepatocellular carcinoma screening.
Main Methods:
- A prospective cohort study compared CHB management in three groups: a dedicated primary care clinic (CIH) with a new registry, gastroenterology (GI) care, and general primary care (PC).
- A CHB registry was implemented at CIH to identify and outreach patients overdue for care.
- Up-to-date (UTD) status was defined by recent laboratory testing and HCC screening. UTD rates were compared before and after registry implementation.
Main Results:
- The study included 4,872 patients. At baseline, GI patients had the highest UTD rate (69%), followed by CIH (51%) and PC (11%).
- After registry implementation, the UTD rate at CIH increased by 11%, while GI care saw a 10% decrease, and PC remained unchanged.
- Registry use standardized care and increased the proportion of CHB patients receiving timely laboratory testing and HCC screening.
Conclusions:
- Implementation of a CHB registry can standardize care and improve adherence to management guidelines.
- Registry-based interventions are effective in increasing laboratory testing and hepatocellular carcinoma screening for CHB patients.
- Targeted outreach through a CHB registry can enhance chronic hepatitis B management in primary care settings.
Abstract:
In the United States, there is poor clinician adherence to the American Association for the Study of Liver Disease and other guidelines for chronic hepatitis B virus (CHB) management. This prospective cohort study evaluated whether a CHB registry improves CHB management. We included patients with CHB aged ≥ 18 years and who had a clinical encounter during September 1, 2016-August 31, 2019. We divided patients into three groups based on care received before September 1, 2019: 1) CIH: primary care clinician at HealthPartners Center for International Health, 2) GI: not CIH and seen by gastroenterology within previous 18 months, and 3) primary care (PC): not CIH and not seen by gastroenterology within previous 18 months. We created and implemented a CHB registry at CIH that allowed staff to identify and perform outreach to patients overdue for CHB management. Patients with laboratory testing (i.e., alanine transaminase and hepatitis B virus DNA) and hepatocellular carcinoma screening in the previous 12 months were considered up to date (UTD). We compared UTD rates between groups at baseline (September 1, 2019) and pilot CHB registry end (February 28, 2020). We evaluated 4,872 patients, 52% of whom were female: 213 CIH, 656 GI, and 4,003 PC. At baseline, GI patients were most UTD (69%) followed by CIH (51%) and PC (11%). At pilot end the percent of UTD patients at CIH increased by 11%, GI decreased by 10%, and PC was unchanged. CHB registry use standardized care and increased the percent of CHB patients with recent laboratory testing and HCC screening.
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