S2391 A Look Behind the Screen: Improving Hepatitis B Virus Screening at an Urban Community Practice

Introduction: The World Health Organization (WHO) estimates that approximately 254 million people worldwide are living with chronic hepatitis B virus (HBV), with 1.2 million new infections occurring each year. According to the most recent data from 2023, the New York State Department of Health reported nearly 7,000 new cases of chronic HBV and approximately 255,000 individuals currently living with the condition. This quality improvement study aims to improve HBV screening at an urban primary care practice. Methods: This study consisted of 2 components. The first involved the implementation of a Best Practice Advisory (BPA) in September 2022 to improve HBV screening. The BPA was integrated into the electronic medical record (EMR) system, providing prompts and guidance to facilitate timely and efficient screening. The second component followed a Plan-Do-Study-Act (PDSA) framework. From April to June 2024, resident physicians at a primary care clinic in New York City participated in a 30-minute educational session. The session focused on current HBV screening guidelines, the epidemiologic burden of the disease, interpretation of screening results, and effective patient communication. Monthly HBV screening across outpatient clinics within a large, multicenter hospital system were centrally monitored and analyzed. Results: Following the implementation of a BPA in September 2022, HBV screening rose and remained stable through 2023. A decline in early 2024 prompted the launch of a targeted educational session from April to June 2024, peaking in May 2024, which was associated with marked improvement in HBV screening. After a brief dip in June 2024 which can be attributed to exposing other rotating cohorts of residents to the educational sessions, an increase in monthly patients screened was seen with a peak of 76 patients in September 2024. A lack of repeated educational sessions compounded by the addition of new residents who had not received the initial sessions led to a decline in screening numbers through the end of 2024 and into 2025. Conclusion: The implementation of the BPA demonstrated that EMR prompts alone led to a transient increase in HBV screening. However, the subsequent introduction of educational sessions highlighted the importance of reinforcing screening practices among providers. The combined effect of both the BPA and education suggests that a dual-modality approach yields more effective and sustained outcomes.