253 - Electronic medical record alert improves tuberculosis screening for pediatric patients

Poster Number: 253
Publication Number: 253.1150

Background: The American Academy of Pediatrics supports interferon-gamma release assay (IGRA) screening for tuberculosis (TB) for pediatric patients >=2 years immigrating from regions with higher TB prevalence, including Asia, Middle East, Africa, Latin America, and countries of the former Soviet Union. Screening is especially important for children under 5 years due to higher risk of progression from infection to disease.

Objective: Among pediatric patients born in countries with higher TB incidence, compare TB screening rates between patients receiving an EMR alert those who have not received the alert. Describe demographic characteristics of pediatric patients meeting the criteria for TB screening.

Design/Methods: To improve TB screening rates we developed an alert in our electronic medical record (EMR), recommending TB screening based on birth country, for medical assistants who are rooming patients for primary care visits. We included all patients ages 2-20 years born in countries with higher TB prevalence and seen in for primary care at 16 clinics from 10/1/2022-9/30/2023 within our integrated safety net health system. We excluded those with previous TB diagnoses or IGRAs. Roll out of the EMR alert was randomized at clinic level and was active at nine or the 16 clinics during the evaluation period, creating a comparison group within the cohort. We collected demographics and calculated receipt of an EMR alert, completion of IGRA, and the IGRA result. We compared IGRA completion and receipt of EMR alert with chi square test and relative risk.

Results: From 10/1/2022 to 9/30/2023, 3,724 pediatric patients were seen in primary care who met the criteria for TB screening. Overall, 772 patients had a EMR alert during the evaluation period, and 650 (17.5%) had an IGRA result with 20 positive, 2 indeterminate, and 628 negative results. Among the 772 who had a EMR alert during the time period, 37.2% had an IGRA, compared to 12.3% for the patients that did not receive an alert in their EMR (p <.001). Patients who had an alert in the EMR were more likely to receive recommended TB screening [RR 1.40, 95% CI: 1.32-1.48].

Conclusion(s): An EMR alert, based on birth country, improved pediatric TB screening rates. Future directions could explore including other risk factors in the EMR alert to further refine risk-factor based TB screening and using of language, race, ethnicity, and social determinants of health data to guide other EMR recommendations and improve screening practices.