title: Using health-system-wide data to understand hepatitis B virus prophylaxis and reactivation outcomes in patients receiving rituximab.
abstract: Hepatitis B virus (HBV) reactivation in the setting of rituximab use is a potentially fatal but preventable safety event. The rate of HBV screening and proportion of patients at risk who receive antiviral prophylaxis in patients initiating rituximab is unknown.We analyzed electronic health record (EHR) data from 2 health systems, a university center and a safety net health system, including diagnosis grouper codes, problem lists, medications, laboratory results, procedures codes, clinical encounter notes, and scanned documents. We identified all patients who received rituximab between 6/1/2012 and 1/1/2016. We calculated the proportion of rituximab users with inadequate screening for HBV according to the Centers for Disease Control guidelines for detecting latent HBV infection before their first rituximab infusion during the study period. We also assessed the proportion of patients with positive hepatitis B screening tests who were prescribed antiviral prophylaxis. Finally, we characterized safety failures and adverse events.We included 926 patients from the university and 132 patients from the safety net health system. Sixty-one percent of patients from the university had adequate screening for HBV compared with 90% from the safety net. Among patients at risk for reactivation based on results of HBV testing, 66% and 92% received antiviral prophylaxis at the university and safety net, respectively.We found wide variations in hepatitis B screening practices among patients receiving rituximab, resulting in unnecessary risks to patients. Interventions should be developed to improve patient safety procedures in this high-risk patient population.
authors.affiliation: Division of Rheumatology, University of California-San Francisco Veterans Affairs Medical Center - San Francisco Center for Vulnerable Populations & Division of General Internal Medicine at the Zuckerberg San Francisco General Hospital, Department of Medicine, University of California-San Francisco University of California-San Francisco , Enterprise Information and Analytics Department of Epidemiology and Biostatistics, University of California-San Francisco Institute for Computational Health Sciences, University of California-San Francisco Center for Healthcare Value, Philip R. Lee Institute for Health Policy Studies, University of California-San Francisco Department of Medicine, University of California-San Francisco.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Schmajuk
authors.forename: Chris
authors.initials: C
authors.lastname: Tonner
authors.forename: Laura
authors.initials: L
authors.lastname: Trupin
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.forename: Urmimala
authors.initials: U
authors.lastname: Sarkar
authors.forename: Dana
authors.initials: D
authors.lastname: Ludwig
authors.forename: Stephen
authors.initials: S
authors.lastname: Shiboski
authors.forename: Marina
authors.initials: M
authors.lastname: Sirota
authors.forename: R Adams
authors.initials: RA
authors.lastname: Dudley
authors.forename: Sara
authors.initials: S
authors.lastname: Murray
authors.forename: Jinoos
authors.initials: J
authors.lastname: Yazdany
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D057286:Electronic Health Records; D005260:Female; D006509:Hepatitis B / Q000139:chemically induced / Q000517:prevention & control*; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000069283:Rituximab / Q000009:adverse effects*; D055502:Secondary Prevention; D055815:Young Adult
chemical_list: D007155:Immunologic Factors; D000069283:Rituximab