Putting “sticky notes” on the electronic medical record to promote intra-hospital referral of hepatitis B and C virus-positive patients to hepatology specialists: an exploratory study

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Abstract

Background

Currently, no system for appropriate intra-hospital collaboration regarding hepatitis virus positive individuals exists, even in medical institutions with hepatologists among their staff. The main objective of this study was to explore a simple alert system to promote the referral of patients with hepatitis B surface antigen (HBsAg)- or anti-hepatitis C virus (HCV) antibodies positivity to hepatologists through electronic medical records.

Methods

Since April 2014 at Osaka City Juso Hospital, “sticky notes” have been put on the electronic medical records of patients newly diagnosed with HBsAg- or anti-HCV- antibodies positivity to recommend intra-hospital referral of those patients to specialists. In this study, we investigated the number of referrals to hepatologists before vs. after the introduction of this system (that is, in fiscal years 2013 [Period 1] and 2014 [Period 2], respectively), and the subsequent clinical courses of the patients.

Results

The proportions of patients with HBsAg and anti-HCV antibody positivity did not show statistically significant differences between Period 1 and Period 2 (1.6 % [43/2,757] vs. 1.3 % [39/2,891], p = 0.58; and 5.8 % [156/2,674] vs. 5.3 % [147/2,790], p = 0.39, respectively). However, the referral proportions for patients with HBsAg- and anti-HCV antibody positivity were significantly higher in Period 2 (73 % [11/15] and 65 % [41/63], respectively) than in Period 1 (28 % [5/18] and 17 % [9/54]) ( p = 0.009 and p < 0.001, respectively). Among patients who were referred to hepatologists, 2 HBsAg-positive and 4 anti-HCV antibody positive patients initiated antiviral treatment.

Conclusion

Our simple electronic medical record based alert system effectively promoted intra-hospital referral of hepatitis virus-positive patients, who have been detected by screening tests, to hepatologists.

Electronic supplementary material

The online version of this article (doi:10.1186/s12879-016-1765-y) contains supplementary material, which is available to authorized users.

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Most cited references 13

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EASL Recommendations on Treatment of Hepatitis C 2015.

(2015)

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A cost-benefit analysis of electronic medical records in primary care.

Blackford Middleton, Anne F Kittler, Benjamin L. Prosser … (2003)

Electronic medical record systems improve the quality of patient care and decrease medical errors, but their financial effects have not been as well documented. The purpose of this study was to estimate the net financial benefit or cost of implementing electronic medical record systems in primary care. We performed a cost-benefit study to analyze the financial effects of electronic medical record systems in ambulatory primary care settings from the perspective of the health care organization. Data were obtained from studies at our institution and from the published literature. The reference strategy for comparisons was the traditional paper-based medical record. The primary outcome measure was the net financial benefit or cost per primary care physician for a 5-year period. The estimated net benefit from using an electronic medical record for a 5-year period was 86,400 US dollars per provider. Benefits accrue primarily from savings in drug expenditures, improved utilization of radiology tests, better capture of charges, and decreased billing errors. In one-way sensitivity analyses, the model was most sensitive to the proportion of patients whose care was capitated; the net benefit varied from a low of 8400 US dollars to a high of 140,100 US dollars . A five-way sensitivity analysis with the most pessimistic and optimistic assumptions showed results ranging from a 2300 US dollars net cost to a 330,900 US dollars net benefit. Implementation of an electronic medical record system in primary care can result in a positive financial return on investment to the health care organization. The magnitude of the return is sensitive to several key factors. Copyright 2003 by Excerpta Medica Inc.

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Maintenance peginterferon therapy and other factors associated with hepatocellular carcinoma in patients with advanced hepatitis C.

T. M. Everson, , Jules Dienstag … (2011)

Interferon reportedly decreases the incidence of hepatocellular carcinoma (HCC) in patients with chronic hepatitis C. The Hepatitis C Antiviral Long-term Treatment against Cirrhosis (HALT-C) Trial showed that 4 years of maintenance therapy with pegylated interferon (peginterferon) does not reduce liver disease progression. We investigated whether peginterferon decreases the incidence of HCC in the HALT-C cohort over a longer posttreatment follow-up period. The study included 1048 patients with chronic hepatitis C (Ishak fibrosis scores ≥ 3) who did not have a sustained virologic response (SVR) to therapy. They were randomly assigned to groups given a half-dose of peginterferon or no treatment (controls) for 3.5 years and followed up for a median of 6.1 (maximum, 8.7) years. Eighty-eight patients developed HCC (68 definite, 20 presumed): 37 of 515 who were given peginterferon (7.2%) and 51 of 533 controls (9.6%; P = .24). There was a significantly lower incidence of HCC among patients given peginterferon therapy who had cirrhosis, but not fibrosis, based on analysis of baseline biopsy samples. After 7 years, the cumulative incidences of HCC in treated and control patients with cirrhosis were 7.8% and 24.2%, respectively (hazard ratio [HR], 0.45; 95% confidence interval [CI], 0.24-0.83); in treated and control patients with fibrosis, incidences were 8.3% and 6.8%, respectively (HR, 1.44; 95% CI, 0.77-2.69). Treated patients with a ≥ 2-point decrease in the histologic activity index, based on a follow-up biopsy, had a lower incidence of HCC than those with unchanged or increased scores (2.9% vs 9.4%; P = .03). Extended analysis of the HALT-C cohort showed that long-term peginterferon therapy does not reduce the incidence of HCC among patients with advanced hepatitis C who did not achieve SVRs. Patients with cirrhosis who received peginterferon treatment had a lower risk of HCC than controls. Copyright © 2011 AGA Institute. Published by Elsevier Inc. All rights reserved.

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Author and article information

Contributors

Hideki Fujii: fujiirola@yahoo.co.jp

Seiko Yamaguchi: seiko_y1226@yahoo.co.jp

Osamu Kurai: kuraion2@gmail.com

Masato Miyano: m_miyano428@yahoo.co.jp

Wataru Ueda: wataru.masahiro.ueda@gmail.com

Hiroko Oba: afprz708@oct.zaq.ne.jp

Tetsuya Aoki: oosama-tetsu@nifty.com

Masaru Enomoto: enomoto-m@med.osaka-cu.ac.jp

Norifumi Kawada: kawadanori@gmail.com

Kiyotaka Okawa: m4027570@msic.med.osaka-cu.ac.jp

Journal

Journal ID (nlm-ta): BMC Infect Dis

Journal ID (iso-abbrev): BMC Infect. Dis

Title: BMC Infectious Diseases

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2334

Publication date (Electronic): 12 August 2016

Publication date PMC-release: 12 August 2016

Publication date Collection: 2016

Volume: 16

Electronic Location Identifier: 410

Affiliations

[1 ]Department of Gastroenterology and Hepatology, Osaka City Juso Hospital, Nonaka-kita, Yodogawa, Osaka 532-0034 Japan

[2 ]Department of Hepatology, Graduate School of Medicine, Osaka City University, Abeno, Osaka 545-8585 Japan

Article

Publisher ID: 1765

DOI: 10.1186/s12879-016-1765-y

PMC ID: 4983008

PubMed ID: 27519695

SO-VID: d3d9bb56-a406-4406-b635-cc9daab62061

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 1 December 2015

Date accepted : 7 August 2016

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100001691, Japan Society for the Promotion of Science;

Award ID: 25461007

Award Recipient : Hideki Fujii

Funded by: Health and Labour Sciences Research Grants

Award ID: H26-Kan-sei-Ippan-001

Award Recipient : Masaru Enomoto

Custom metadata

ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: hepatitis b virus,hepatitis c virus,screening,intra-hospital referral

Data availability:

ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: hepatitis b virus, hepatitis c virus, screening, intra-hospital referral

Putting “sticky notes” on the electronic medical record to promote intra-hospital referral of hepatitis B and C virus-positive patients to hepatology specialists: an exploratory study

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Background

Methods

Results

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Electronic supplementary material

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Point-Of-Care Testing for Hepatitis

Most cited references 13

EASL Recommendations on Treatment of Hepatitis C 2015.

A cost-benefit analysis of electronic medical records in primary care.

Maintenance peginterferon therapy and other factors associated with hepatocellular carcinoma in patients with advanced hepatitis C.

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