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Improving Hepatitis B Screening Prior to Rituximab: A Quality Improvement Project

Rituximab, used in the treatment of some rheumatic and kidney diseases, can lead to hepatitis B virus (HBV) reactivation; HBV screening is recommended for those starting this medication. We aimed to improve by 50% the proportion of patients undergoing HBV screening by implementing multimodal interve...

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Autores principales: Villacis-Nunez, D. Sofia, Orenstein, Evan, Selvaggio, Phyllis, Rouster-Stevens, Kelly, Wang, Chia-shi, Thakral, Amit
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10378200/
https://www.ncbi.nlm.nih.gov/pubmed/37508639
http://dx.doi.org/10.3390/children10071142
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author Villacis-Nunez, D. Sofia
Orenstein, Evan
Selvaggio, Phyllis
Rouster-Stevens, Kelly
Wang, Chia-shi
Thakral, Amit
author_facet Villacis-Nunez, D. Sofia
Orenstein, Evan
Selvaggio, Phyllis
Rouster-Stevens, Kelly
Wang, Chia-shi
Thakral, Amit
author_sort Villacis-Nunez, D. Sofia
collection PubMed
description Rituximab, used in the treatment of some rheumatic and kidney diseases, can lead to hepatitis B virus (HBV) reactivation; HBV screening is recommended for those starting this medication. We aimed to improve by 50% the proportion of patients undergoing HBV screening by implementing multimodal interventions to support clinicians in this evidence-based practice. We conducted a quality improvement project from November 2020 to June 2022 at a tertiary care pediatric hospital system, including patients with rheumatic and/or kidney diseases starting rituximab. Multimodal interventions targeting clinicians included electronic health tools (dot phrase, display of screening recommendations and screening results in rituximab order sets/therapy plans), educational meetings, and e-mail/paper reminders. The primary outcome was the proportion of patients with complete HBV screening, while the secondary outcome was utilization of each laboratory component, tracked using statistical process control charts. Pre- and post-intervention data were compared using Fisher’s test. One hundred eighty-two patients who had been prescribed rituximab were included, of which 98 (54%) were post-intervention. The proportions of patients undergoing complete HBV screening (6% vs. 44%; p < 0.001), HBsAg collection (60% vs. 79%; p = 0.006), anti-HBsAb collection (14% vs. 54%; p < 0.001), and total anti-HBcAb collection (8% vs. 52%; p < 0.001) were significantly higher in the post-intervention period. Improvement was sustained over 18 months, with shifts and/or data points above the control limits in all measures. Forty-five patients were HBV-non-immune. In this study, multimodal interventions including electronic health tools and education of the provider significantly increased the proportion of patients screened for HBV prior to rituximab and identified immunization opportunities.
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spelling pubmed-103782002023-07-29 Improving Hepatitis B Screening Prior to Rituximab: A Quality Improvement Project Villacis-Nunez, D. Sofia Orenstein, Evan Selvaggio, Phyllis Rouster-Stevens, Kelly Wang, Chia-shi Thakral, Amit Children (Basel) Article Rituximab, used in the treatment of some rheumatic and kidney diseases, can lead to hepatitis B virus (HBV) reactivation; HBV screening is recommended for those starting this medication. We aimed to improve by 50% the proportion of patients undergoing HBV screening by implementing multimodal interventions to support clinicians in this evidence-based practice. We conducted a quality improvement project from November 2020 to June 2022 at a tertiary care pediatric hospital system, including patients with rheumatic and/or kidney diseases starting rituximab. Multimodal interventions targeting clinicians included electronic health tools (dot phrase, display of screening recommendations and screening results in rituximab order sets/therapy plans), educational meetings, and e-mail/paper reminders. The primary outcome was the proportion of patients with complete HBV screening, while the secondary outcome was utilization of each laboratory component, tracked using statistical process control charts. Pre- and post-intervention data were compared using Fisher’s test. One hundred eighty-two patients who had been prescribed rituximab were included, of which 98 (54%) were post-intervention. The proportions of patients undergoing complete HBV screening (6% vs. 44%; p < 0.001), HBsAg collection (60% vs. 79%; p = 0.006), anti-HBsAb collection (14% vs. 54%; p < 0.001), and total anti-HBcAb collection (8% vs. 52%; p < 0.001) were significantly higher in the post-intervention period. Improvement was sustained over 18 months, with shifts and/or data points above the control limits in all measures. Forty-five patients were HBV-non-immune. In this study, multimodal interventions including electronic health tools and education of the provider significantly increased the proportion of patients screened for HBV prior to rituximab and identified immunization opportunities. MDPI 2023-06-30 /pmc/articles/PMC10378200/ /pubmed/37508639 http://dx.doi.org/10.3390/children10071142 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Villacis-Nunez, D. Sofia
Orenstein, Evan
Selvaggio, Phyllis
Rouster-Stevens, Kelly
Wang, Chia-shi
Thakral, Amit
Improving Hepatitis B Screening Prior to Rituximab: A Quality Improvement Project
title Improving Hepatitis B Screening Prior to Rituximab: A Quality Improvement Project
title_full Improving Hepatitis B Screening Prior to Rituximab: A Quality Improvement Project
title_fullStr Improving Hepatitis B Screening Prior to Rituximab: A Quality Improvement Project
title_full_unstemmed Improving Hepatitis B Screening Prior to Rituximab: A Quality Improvement Project
title_short Improving Hepatitis B Screening Prior to Rituximab: A Quality Improvement Project
title_sort improving hepatitis b screening prior to rituximab: a quality improvement project
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10378200/
https://www.ncbi.nlm.nih.gov/pubmed/37508639
http://dx.doi.org/10.3390/children10071142
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