Biologic readiness: Improving tuberculosis screening in an adult allergy and immunology clinic

In outpatient allergy settings serving historically underserved populations, compliance with Mycobacterium tuberculosis (TB) screening and documentation remains challenging.

We evaluated TB screening compliance among adult allergy patients receiving biologic therapy to identify workflow gaps that contribute to incomplete screening.

We conducted a quality improvement project within the Division of Adult Allergy and Immunology at Maimonides Health, an urban academic medical center in Brooklyn, New York, serving a diverse patient population with significant social and medical complexity. Demographic and clinical data were collected from patients receiving biologic therapy between 2023 and 2025. TB screening completion and documentation rates were analyzed using descriptive statistics. A FOCUS-PDCA (find, organize, clarify, understand, select; plan, do, check, act) framework was applied to identify sources of process variation and to develop standardized workflow interventions.

Among 141 patients receiving biologic therapy, only 46.81% had documented TB screening results, leaving 53.19% without evidence of completed testing. The mean patient age was 43 years, with most patients aged between 30-44 and 45-59 years. Omalizumab (61%) and dupilumab (38%) were the most frequently prescribed biologics. Major contributors to incomplete TB screening included inconsistent documentation, lack of automated electronic medical record alerts, variable workflows across clinical sites, and patient noncompletion of laboratory testing.

Implementing standardized TB screening workflows, improving laboratory follow-up processes, and enhancing patient education may significantly improve compliance. Targeting frequently utilized biologic therapies offers an efficient strategy for system-wide improvement.