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Improving Hepatitis B Screening Prior to Rituximab: A Quality Improvement Project
D Sofia Villacis-Nunez1,2, Evan Orenstein2,3, Phyllis Selvaggio2
1Division of Pediatric Rheumatology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA.
Children (Basel, Switzerland)
|July 29, 2023
Summary
Hepatitis B virus (HBV) screening is crucial before rituximab treatment. Multimodal interventions significantly improved HBV screening rates in pediatric patients, identifying those needing immunization.
Area of Science:
- Rheumatology
- Nephrology
- Infectious Diseases
- Quality Improvement Science
Background:
- Rituximab therapy for rheumatic and kidney diseases poses a risk of hepatitis B virus (HBV) reactivation.
- Current guidelines recommend HBV screening for patients initiating rituximab.
- Adherence to HBV screening protocols remains a challenge in clinical practice.
Purpose of the Study:
- To enhance HBV screening rates by at least 50% in pediatric patients receiving rituximab.
- To implement and evaluate multimodal interventions supporting evidence-based HBV screening practices.
- To improve the identification of HBV-non-immune patients requiring vaccination or monitoring.
Main Methods:
- A quality improvement project was conducted at a tertiary pediatric hospital system from November 2020 to June 2022.
- Multimodal interventions included electronic health tools (dot phrases, order set integration), educational meetings, and reminders.
- Statistical process control charts tracked screening proportions and laboratory utilization; pre- and post-intervention data were compared using Fisher's exact test.
Main Results:
- The proportion of patients with complete HBV screening increased significantly from 6% to 44% (p < 0.001).
- Rates of HBsAg, anti-HBsAb, and total anti-HBcAb collection also showed significant improvement post-intervention.
- Sustained improvement was observed over 18 months, with all measures showing positive trends.
Conclusions:
- Multimodal interventions, particularly electronic health tools and provider education, effectively increased HBV screening rates prior to rituximab initiation.
- The project successfully identified HBV-non-immune patients, highlighting opportunities for timely immunization.
- These interventions are crucial for mitigating HBV reactivation risks in vulnerable patient populations.
