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Department of Public Health Performance Profile Hepatitis B Screening Vaccination & Surveillance Hep B Free – IPA Presentation Albert Yu, MD, MPH, MBA.

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Presentation on theme: "Department of Public Health Performance Profile Hepatitis B Screening Vaccination & Surveillance Hep B Free – IPA Presentation Albert Yu, MD, MPH, MBA."— Presentation transcript:

1 Department of Public Health Performance Profile Hepatitis B Screening Vaccination & Surveillance Hep B Free – IPA Presentation Albert Yu, MD, MPH, MBA Director, SFDPH Chinatown Public Health Center Clinical Professor, UCSF Department of Family & Community Medicine Mandana Khalili, MD, MAS Chief of Clinical Hepatology Associate Professor of Medicine, UCSF

2 Targeting Viral Hepatitis (HBV) as a System-Wide QI Priority 30% of patients within CHN are APIs Gaps between national guidelines & PCP knowledge and practice patterns A joint specialist-PCP CHN working group was established to address these gaps HBV data (labs, vaccination, imaging) are searchable from EHR and registry Leverage established QI infrastructure: –Share best practices & practice innovations –Provide technical assistance & regular reports –Develop population-based strategies

3 Patient Demographics Total Active Patients% API Clinic 1 4,8008% Clinic 2 5,22091% Clinic 3 4,19221% Clinic 4 3,50454% Clinic 5 3,29815% Clinic 6 3,98937% Clinic 7 4,51712% Subtotal29,52035% Clinic 1 17142% Clinic 2 1,00528% Clinic 3 1,33627% Clinic 4 1,2315% Clinic 5 69511% Clinic 6 4,9655% Subtotal9,40312% Clinic 1 10,45727% Clinic 2 6,25929% Subtotal16,71628%

4 Hepatitis B and Hepatocellular Carcinoma Screening Among Asian Americans: Survey of Safety Net Healthcare Providers Mandana Khalili, Jennifer Guy, Albert Yu, Alexander Li, Nadia Diamond- Smith, Susan Stewart, Moon Chen Jr., and Tung Nguyen Dig Dis Sci. 2010 Nov 3 Only 76% had screened >50% of their Asian patients for Hepatitis B and 43% had vaccinated >50% of eligible patients against Hepatitis B Higher provider knowledge was associated with liver cancer screening Hepatitis B and liver cancer screening rates and Hepatitis B vaccination among Asians from physician report is suboptimal

5 Screening for HBV Among APIs? CLINIC3/4/2010 AB Clinic 127.7816.3 Clinic 263.3921.99 Clinic 360.997.76 Clinic 443.6336.01 Clinic 527.4316.02 Clinic 637.9425.06 Clinic 752.725.16 Clinic 812.70 Clinic 956.5116.44 Clinic 1059.7114.38 Clinic 1188.724.85 Clinic 122.5 Clinic 133.181.82 Clinic 1440.3824.12 Clinic 1565.525.17 Clinic 1611.592.9 Clinic 1760.6610.66 TOTAL41.9216.3 A % API pts with both HBsAg HBsAb B % API pts with ONLY HBsAg

6 Screening HBV Appropriately?

7 Vaccinating Against HBV Cost-Effectively & Appropriately? CLINIC AB1B2C Clinic 1 60.8752.731.827.27 Clinic 2 74.0916.152.1315.14 Clinic 3 43.1818.253.9711.9 Clinic 4 73.7215.833.4714.29 Clinic 5 61.29206.67 Clinic 6 59.8721.655.519.06 Clinic 7 39.0221.1511.5423.08 Clinic 8 5081.25010.42 Clinic 9 38.7915.973.316.15 Clinic 10 20.836.74.1221.65 Clinic 11 39.478.33050 Clinic 12 5090.4804.76 Clinic 13 71.4379.1700 Clinic 14 10.8710.53 0 Clinic 15 41.1827.785.5627.78 Clinic 16 66.6775012.5 Clinic 17 43.9610.613.0325.76 28.8421.033.3715.02 TOTAL A sAg – sAb – B1 inappropriate sAg + / ? sAb B2 unnecessary sAg – sAb + C sAb after vaccines

8 Managing CHB Carriers Appropriately? A HAV Ab + HAV – & vac B HCV screen C HIV screen CLINIC 3/4/2010 ABC Clinic 1 51.1131.1122.22 Clinic 2 90.4626.4310.08 Clinic 3 60.2337.530.68 Clinic 4 78.4716.6713.19 Clinic 5 754530 Clinic 6 45.4539.7721.59 Clinic 7 42.8658.93 Clinic 8 000 Clinic 9 59.5632.8932 Clinic 10 50.6327.528.75 Clinic 11 79.8849.78.28 Clinic 12 Clinic 13 10000 Clinic 14 03035 Clinic 15 801540 Clinic 16 066.670 Clinic 17 72.1530.3827.85 TOTAL 62.8431.8321.83

9 A ALT past 12m B1 HBV DNA within 12m diagnosis B2 HBV DNA within 12m of diagnosis or past 12m C HBeAg past 12m CLINIC3/4/2010 AB1B2C Clinic 1 808.8917.7835.56 Clinic 2 79.0222.3455.5946.59 Clinic 3 7534.0959.0968.18 Clinic 4 80.5615.9733.3335.42 Clinic 5 752545 Clinic 6 73.8643.187568.18 Clinic 7 73.2123.2139.2960.71 SUBTOTAL 77.8524.1350.6249.63 Clinic 1 0000 Clinic 2 79.5634.2271.1157.78 Clinic 3 78.1333.1355.6358.13 Clinic 4 88.7626.0446.1546.75 SUBTOTAL 81.831.3558.9254.41 Clinic 1 Clinic 2 0000 Clinic 3 65102025 Clinic 4 65204035 Clinic 5 100000 Clinic 6 64.5616.4621.5231.65 SUBTOTAL 65.0415.4523.5830.08 TOTAL 74.4426.2751.0149.94 Managing CHB Carriers Appropriately?

10 Screening CHB Carriers for HCC?

11 AFP and Imaging past 12m CLINIC 3/4/2010 Clinic 1 25 Clinic 2 14.93 Clinic 3 36.84 Clinic 4 43.27 Clinic 5 40 Clinic 6 25 Clinic 7 11.11 Clinic 8 0 Clinic 9 44.72 Clinic 10 28.3 Clinic 11 25 Clinic 12 Clinic 13 Clinic 14 12.5 Clinic 15 33.33 Clinic 16 Clinic 17 11.11 TOTAL 18.28 Screening CHB Carriers for HCC?

12 Barriers to HCC Screening?

13 Screening & Vaccination Guidelines Chronic Hepatitis B Surveillance and Management Algorithm

14 How Can We Collectively Leverage Each Others Strengths & Secure The Necessary Resources (External & Internal) In Order To Create A Learning Medical Community in SF (Bay Area) Where We Can Show The Nation That The Entire City (much like HBF in raising public awareness) Can Achieve Collectively Top Measurable Outcomes (screening, vaccination & management)?


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