S3156 Assessing Helicobacter pylori Testing and Treatment by Providers at an Academic Tertiary Medical Center: A Quality Improvement Project

Introduction: Helicobacter pylori infection (HPI) is one of the most common infections worldwide. In 2018, we started a quality improvement (QI) project at our multihospital urban tertiary care academic center to improve management of HPI. To assess baseline knowledge, in 2018 we performed an institutional review board (IRB)–approved survey of primary care and gastroenterology (GI) providers and found 20% were considering serology as a diagnostic option, 50% were treating asymptomatic patients with HPI, 15% were primarily treating with Proton pump inhibitor-bismuth-metronidazole-tetracycline (PBMT), 38% were always checking for eradication, and 98% said local resistance information for HPI would be helpful. As a result, we had multifold aims including assessing local resistance and improving provider guideline adherence. Methods: Interventions started in 2018 by collecting prospective culture-based resistance data on a subset of patients with HPI and retrospective analysis of eradication success based on treatment, both suggesting >25% clarithromycin resistance. Educational initiatives included presenting this information at grand rounds for medicine and family medicine departments in 2023 and residency academic lectures in 2025. In 2025, our team created electronic medical record (EMR) order sets with options for 2 first-line medication regimens based on local and national data along with eradication testing orders. From April-May 2025, we sent a 14-question anonymous, IRB-approved survey to current residents (medicine-pediatrics, family, and internal medicine), primary care, and GI providers at our center regarding their HPI management practices. Results: One-hundred eight providers participated in the re-assessment survey. Key results include that 8% of providers are using serology for diagnosis, 69% are treating asymptomatic patients with HPI, 81% primarily prescribe PBMT, and 78% always tested for eradication. Fourteen percent of providers are primarily prescribing proton pump inhibitor-amoxicillin-clarithromycin (PAC). Conclusion: Compared to 2018, 5 times more providers are primarily prescribing PBMT and almost 2 times more are consistently testing for eradication, likely as a result of updated national guidelines and local educational and standardization initiatives. However, 1 in 7 are still primarily prescribing PAC and nearly 1 in 5 are inconsistently ordering eradication testing. Our survey had limited capture of advanced practice providers and attending physicians. Next steps include promoting EMR order set use and reaching out to individual clinics for education.