Using Electronic Health Record Data to Measure the Latent Tuberculosis Infection Care Cascade in Safety-Net Primary...

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Health Services Research

Background:

• Latent tuberculosis infection (LTBI) management is crucial for tuberculosis elimination in the U.S.
• Safety-net primary care settings serve high-risk populations for tuberculosis
• Optimizing LTBI care requires understanding the care cascade and identifying barriers

Purpose of the Study:

• To describe the LTBI care cascade in a network of U.S. safety-net primary care clinics
• To identify gaps in LTBI testing, diagnosis, and treatment within this network
• To inform strategies for improving tuberculosis prevention in primary care

Main Methods:

• Utilized electronic health record data from the OCHIN Clinical Network (2012-2019)
• Measured the LTBI care cascade: screening, testing, diagnosis, and treatment initiation
• Stratified outcomes by diagnostic test and treatment regimen

Main Results:

• Of 1.9 million patients, 43.5% met screening criteria, but only 21.4% were tested for LTBI
• Among those tested, 10.5% were diagnosed with LTBI, and 29.1% were prescribed treatment
• Only 33.6% of treated patients received a recommended rifamycin-based regimen

Conclusions:

• Electronic health records are effective for monitoring the LTBI care cascade
• A substantial proportion of patients in safety-net clinics are at high risk for tuberculosis
• Addressing identified gaps in LTBI care can enhance tuberculosis prevention and accelerate elimination efforts