Electronic Messages Increase Hepatitis B Screening in At-Risk Asian American Patients: A Randomized, Controlled Trial
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Hepatitis B (HBV) induced hepatocellular carcinoma is the greatest cancer health disparity affecting Asian Americans, but the prevalence of screening to detect HBV is suboptimal.
Our aims were to determine the effectiveness of electronic health record (EHR) prompts to increase ordering of HBV tests among primary care providers (PCPs) within an academic health system.
We conducted a randomized, controlled trial between April and June 2011 among 76 PCPs caring for 175 outpatient adults with Chinese or Vietnamese surnames, with appointments with providers and no history of HBV testing. Providers were randomized to either receive an EHR prompt for HBV testing prior to patients’ appointments or usual care. Primary outcomes were the proportion of patients (1) whose physician ordered a HBsAg test and (2) who completed testing. Secondary outcomes were (A) test results and (B) whether the physicians followed-up on the results.
HBsAg tests were ordered for 36/88 (40.9 %) of the intervention patients and 1/87 (1.1 %) of the control patients [χ 2 (df = 1) = 41.48, p < 0.001]. Thirty intervention patients (34.1 %) and no control patients completed the HBsAg test [χ 2 (df = 1) = 35.80, p < 0.001]. Four (13.3 %) of the completed tests were HBsAg-positive, 14 (46.7 %) were immune, and 12 (40 %) were unprotected from HBV. Two HBsAg-positive patients were referred to specialists, and 3 unprotected patients were vaccinated for HBV.
EHR-based provider prompts significantly increased HBV testing in Chinese and Vietnamese patients when compared to “usual care.” EHR prompts are a promising intervention that could significantly increase screening for HBV.
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- Electronic Messages Increase Hepatitis B Screening in At-Risk Asian American Patients: A Randomized, Controlled Trial
Digestive Diseases and Sciences
Volume 58, Issue 3 , pp 807-814
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- Springer US
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- Hepatitis B
- Hepatocellular carcinoma
- Electronic health record
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- Author Affiliations
- 1. School of Medicine, University of California, Davis, Sacramento, CA, USA
- 6. 4800 2nd Avenue, Suite 2200, Sacramento, CA, 95817, USA
- 3. Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of California, Davis, 4150 V Street, PSSB 3500, Sacramento, CA, 95817, USA
- 2. Department of Public Health Sciences, University of California, Davis, 4800 2nd Avenue, Suite 2200, Sacramento, CA, 95817, USA
- 4. UC Davis Division of Burn Surgery, Clinical and Translational Science Center, 2921 Stockton Blvd Suite 1400, Sacramento, CA, 95817, USA
- 5. Division of Hematology and Oncology, Department of Internal Medicine, University of California, Davis, 4800 2nd Avenue, Suite 2207, Sacramento, CA, 95817, USA