Improving Screening and Vaccination Rate for Hepatitis B in Veterans Affair Primary Care Population: A Quality Improvement Study

From the 2023 HVPA National Conference

Zhuo Yu DO (Stony Brook University Hospital), Lisa Fisher MD (Northport VA Medical Center)

Background:
According to Advisory Committee on Immunization Practices (ACIP), acute infection with Hepatitis B virus (HBV) is rising among adults 40 years and older. Hepatitis B (HepB) vaccines have long demonstrated safety and efficacy for decades, however less than a third of U.S. adults reported being vaccinated against HBV in 2018. The past strategy of offering HepB vaccine only to those who were at risk was noted to be insufficient. In 2022, ACIP updated its recommendation and advised vaccinating all adults aged 19-59 and those 60 years and older with risk factors; adults 60 years and older without known risk factors may also be vaccinated. 

Objective:
Our project aims to improve HBV screening and vaccination rate among Veterans Affairs (VA) primary care clinic patient population. We would like to do so by spreading awareness of the new Hepatitis B vaccination guideline to all VA clinicians with various low cost interventions. 

Methods:
Data was collected from pre-intervention (October – December 2021) and post-intervention (March – May 2022); all patients seen in clinic during these months were included. Patients were considered immune against HBV from vaccination if they have positive anti-HBsAg; and susceptible to infection if hepatitis panel negative. Interventions include educating each resident group regarding update in vaccination guideline and hepatitis panel interpretation. Reminder poster regarding HBV vaccine was placed in each clinic room. In addition, reminder for checking HepB vaccination status was developed and embedded in VA electronic medical record (EMR) system, and each physician will be reminded of checking HepB status at the end of each visit.

Results:
In the pre-intervention period from October to December 2021, a total of 1242 veterans were seen in primary care clinic. 532 veterans were screened for immunity in the past with 378 veterans noted to have no immunity against hepatitis B. Out of 378 non-immune veterans, only 35 patients were vaccinated against HepB.

In the post-intervention period from March to May 2022, 1174 veterans were seen. 689 veterans were screened for immunity and 402 have no immunity against HBV on hepatitis panel. Out of 402 non-immune veterans, 123 veterans received HepB vaccination during clinic visit, which is more than 20% increase compared to prior.

Conclusions:
Our data suggest that HBV vaccination rate was suboptimal among veteran population. A low-cost intervention along with the help of technology could be beneficial in integrating new vaccination guideline in VA standard of care.

Clinical Implications:
Our project strikes to encourage clinicians to bear the responsibility and offer the vaccine to adult patients proactively, rather than wait for patients to request for it. The goal of this project is to increase awareness of new vaccination guideline and strike to reach for full vaccination rate among our veteran population.

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