Improving Care for Patients with Chronic Hepatitis B via Establishment of a Disease Registry

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  • 1 HealthPartners Institute, Bloomington, Minnesota;
  • | 2 Department of Medicine, University of Minnesota, Minneapolis, Minnesota;
  • | 3 HealthPartners Center for International Health, Bloomington, Minnesota;
  • | 4 HealthPartners Travel and Tropical Medicine Center, Bloomington, Minnesota

In the United States, there is poor clinician adherence to the American Association for the Study of Liver Disease and other guidelines for chronic hepatitis B virus (CHB) management. This prospective cohort study evaluated whether a CHB registry improves CHB management. We included patients with CHB aged ≥ 18 years and who had a clinical encounter during September 1, 2016–August 31, 2019. We divided patients into three groups based on care received before September 1, 2019: 1) CIH: primary care clinician at HealthPartners Center for International Health, 2) GI: not CIH and seen by gastroenterology within previous 18 months, and 3) primary care (PC): not CIH and not seen by gastroenterology within previous 18 months. We created and implemented a CHB registry at CIH that allowed staff to identify and perform outreach to patients overdue for CHB management. Patients with laboratory testing (i.e., alanine transaminase and hepatitis B virus DNA) and hepatocellular carcinoma screening in the previous 12 months were considered up to date (UTD). We compared UTD rates between groups at baseline (September 1, 2019) and pilot CHB registry end (February 28, 2020). We evaluated 4,872 patients, 52% of whom were female: 213 CIH, 656 GI, and 4,003 PC. At baseline, GI patients were most UTD (69%) followed by CIH (51%) and PC (11%). At pilot end the percent of UTD patients at CIH increased by 11%, GI decreased by 10%, and PC was unchanged. CHB registry use standardized care and increased the percent of CHB patients with recent laboratory testing and HCC screening.

Author Notes

Address correspondence to Malini B. DeSilva, HealthPartners Institute, 8170 33rd Ave. South, MS21112R, Bloomington, MN 55440-1524. E-mail: malini.b.desilva@healthpartners.com

Financial support: This work was supported by grant funding from the Centers for Disease Control and Prevention Centers for Excellence in Refugee Health, contract nos. NU50CK000475-04-00 and NU50CK000459-04-00.

Authors’ addresses: Malini B. DeSilva, HealthPartners Institute, Bloomington, MN, and HealthPartners Travel and Tropical Medicine Center, Bloomington, MN, E-mail: malini.b.desilva@healthpartners.com. Ann Settgast, HealthPartners Institute, Bloomington, MN, Department of Medicine, University of Minnesota, Minneapolis, MN, HealthPartners Center for International Health, Bloomington, MN, HealthPartners Travel and Tropical Medicine Center, Bloomington, MN, E-mail: ann.m.settgast@healthpartners.com. Ella Chrenka, HealthPartners Institute, Bloomington, MN, E-mail: ella.a.chrenka@healthpartners.com. Amy J. Kodet, HealthPartners Institute, Bloomington, MN, E-mail: amy.j.kodet@healthpartners.com. Patricia F. Walker, HealthPartners Institute, Bloomington, MN, Department of Medicine, University of Minnesota, Minneapolis, MN, and Tropical Medicine Center, Bloomington, MN, E-mail: patricia.f.walker@healthpartners.com.

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