Identifying MTB-exposed homeless persons with an electronic health record alert: a safety-net health system’s experience

<sec><title>BACKGROUND</title>Safety-net health systems and public health have a unique opportunity to collaborate and address <i>Mycobacterium tuberculosis</i> (MTB) in persons experiencing homelessness (PEH) in the United States (US).</sec><sec><title>METHODS</title>At a large academic safety-net health system in the US, from July 2013 to July 2015, we implemented a novel electronic health record (EHR) alert for physicians to identify, counsel, and order interferon-γ release assay screening tests for PEH potentially exposed to MTB in homeless shelters. Retrospectively, we collected socio-demographic, clinical, and genotyping data for all patients diagnosed with MTB disease from 2008 to 2017 and performed data analysis.</sec><sec><title>RESULTS</title>The EHR alert flagged 2,118 of 8,649 (24.5%) individuals; 1,117 (52.7%) were screened for MTB, and 313 (28%) tested positive. MTB disease was diagnosed in 531 patients from 2008 to 2017, of which 37 were among the potentially exposed 8,649 PEH. Housing instability was identified in 135 (25.4%) TB patients. Three genotypes were predominant: G10508 (56, 14.2%), G01521 (23, 5.8%), and G10509 (19, 4.8%).</sec><sec><title>CONCLUSION</title>A novel EHR alert was useful in identifying and increasing testing among potentially TB-exposed PEH. Housing instability and genotypic clustering were prominent among patients with MTB diagnosis.</sec>.