Comparing ways to increase hepatitis B and C screening among Asian Americans / Tung T. Nguyen.

Format:

Book

Author/Creator:

Nguyen, Tung T., author.

Language:

English

Subjects (All):

Liver--Diseases--Diagnosis.

Liver.

Outcome assessment (Medical care).

Physical Description:

1 online resource (70 pages)

Place of Publication:

Washington, D.C. : Patient-Centered Outcomes Research Institute (PCORI), 2019.

Summary:

BACKGROUND: Liver cancer and hepatitis B (HBV) are significant health disparities for Asian Americans, and little is known about hepatitis C (HCV) among that population. There are few studies of interventions to increase screening for viral hepatitis in this population. OBJECTIVE: To develop, implement, and test the efficacy of a mobile application (app) in 4 languages to increase screening for hepatitis B and C among Asian Americans. METHODS: Using patient-centered methods, we developed mobile applications (apps) for tablets in English, Cantonese, Mandarin, and Vietnamese. The app for the intervention group addressed hepatitis B and C (hepatitis screening); the app for the comparison group addressed nutrition and physical activity (NPA). Each app had questions for the patient to answer. Depending on the responses, the tablet generated audiovisual messages and a printed summary (provider alert) of the patient's hepatitis screening status and recommendations to give to the provider. Primary care providers (PCPs) at an academic medical center or a county hospital and their patients were cluster randomized at the provider level to the hepatitis screening (intervention) or comparison NPA (comparison) arms. Eligible patients were Asian Americans aged 18 and older who spoke one of the languages and had not been screened previously for HBV. Every 6 months, providers in both arms received a list of their patients (provider panel notification) who had not been tested for HBV. Intervention and comparison patients used the hepatitis screening and NPA app, respectively, prior to a health visit. Data sources included electronic health records and surveys conducted prior to, immediately after, and 3 months after the visit. The primary outcome was a screening test for hepatitis B or C. RESULTS: We enrolled and randomized 189 providers and their patients. Among 452 patients, the average age was 56.8 years, with 64.0% female, 79.7% non-US born, 47.1% married, 61.1% having completed college, and 56.2% speaking English well or fluently. We found no significant statistical differences in these characteristics between patients in the intervention (N = 270) or comparison (N = 182) arms. At postvisit, intervention patients were more likely than comparison patients to report discussing HBV (70.4% vs 16.5%; P < .001) or HCV (62.6% vs 12.6%; P < .001) with their providers. They were also more likely to report a provider recommendation to test for HBV (51.1% vs 13.2%; P < .001) or HCV (37.8% vs 9.9%; P < .001) and were more likely to ask for a test for HBV (58.9% vs 9.3%; P < .001) or HCV (51.5% vs 6.6%; P < .001). Intervention group participants were more likely to have a screening test ordered (44.1% vs 9.9%; P < .001) and completed for HBV (37.8% vs 7.7%; P < .001). Among eligible patients, the intervention group was more likely to have a test ordered (38.6% vs 10.0%; P < .001) and completed (30.3% vs 6.0%; P < .001) for HCV. In multivariable analyses, the intervention odds ratio (OR) for HBV test ordering was 7.6 (95% CI, 3.9-14.8) and test receipt was 7.5 (95% CI, 3.6-15.5). Among eligible patients, the intervention OR for HCV test ordering was 8.8 (95% CI, 3.1-24.8) and for receipt was 10.5 (95% CI, 3.0-36.8). LIMITATIONS: This study was not blinded. The patients were drawn from only 1 geographic area, and only Asian Americans who spoke English, Chinese (Cantonese or Mandarin), or Vietnamese were eligible. CONCLUSION: A multilingual mobile app led to more patient-provider discussion about viral hepatitis and screening test receipt. Technology can improve health care quality among Asian Americans.

Notes:

Description based on publisher supplied metadata and other sources.

Includes bibliographical references.