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Albert Yu, MD, MPH, MBA Director, SFDPH Chinatown Public Health Center

Department of Public Health Performance Profile Hepatitis B Screening Vaccination & Surveillance Hep B Free – IPA Presentation. Albert Yu, MD, MPH, MBA Director, SFDPH Chinatown Public Health Center Clinical Professor, UCSF Department of Family & Community Medicine Mandana Khalili, MD, MAS

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Albert Yu, MD, MPH, MBA Director, SFDPH Chinatown Public Health Center

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  1. Department of Public HealthPerformance Profile Hepatitis B ScreeningVaccination & SurveillanceHep B Free – IPA Presentation Albert Yu, MD, MPH, MBA Director, SFDPH Chinatown Public Health Center Clinical Professor, UCSF Department of Family & Community Medicine Mandana Khalili, MD, MAS Chief of Clinical Hepatology Associate Professor of Medicine, UCSF

  2. Targeting Viral Hepatitis (HBV) as a System-Wide QI Priority • 30% of patients within CHN are APIs • Gaps between national guidelines & PCP knowledge and practice patterns • A joint specialist-PCP CHN working group was established to address these gaps • HBV data (labs, vaccination, imaging) are searchable from EHR and registry • Leverage established QI infrastructure: • Share best practices & practice innovations • Provide technical assistance & regular reports • Develop population-based strategies

  3. Patient Demographics

  4. Hepatitis B and Hepatocellular Carcinoma Screening Among Asian Americans: Survey of Safety Net Healthcare Providers Mandana Khalili, Jennifer Guy, Albert Yu, Alexander Li, Nadia Diamond-Smith, Susan Stewart, Moon Chen Jr., and Tung Nguyen • Only 76% had screened >50% of their Asian patients for Hepatitis B and 43% had vaccinated >50% of eligible patients against Hepatitis B • Higher provider knowledge was associated with liver cancer screening • Hepatitis B and liver cancer screening rates and Hepatitis B vaccination among Asians from physician report is suboptimal Dig Dis Sci. 2010 Nov 3

  5. Screening for HBV Among APIs? A % API pts with both HBsAg HBsAb B % API pts with ONLY HBsAg

  6. Screening HBV Appropriately?

  7. Vaccinating Against HBV Cost-Effectively & Appropriately? A sAg – sAb – B1 inappropriate sAg + / ? sAb B2 unnecessary sAg – sAb + C sAb after vaccines

  8. Managing CHB Carriers Appropriately? A HAV Ab + HAV – & vac B HCV screen C HIV screen

  9. Managing CHB Carriers Appropriately? A ALT past 12m B1 HBV DNA within 12m diagnosis B2 HBV DNA within 12m of diagnosis or past 12m C HBeAg past 12m

  10. Screening CHB Carriers for HCC?

  11. Screening CHB Carriers for HCC? AFP and Imaging past 12m

  12. Barriers to HCC Screening?

  13. Screening & Vaccination GuidelinesChronic Hepatitis B Surveillance and Management Algorithm

  14. How Can We Collectively Leverage Each Other’s Strengths & Secure The Necessary Resources (External & Internal) In Order To Create A Learning Medical Community in SF (Bay Area) Where We Can Show The Nation That The Entire City (much like HBF in raising public awareness) Can Achieve Collectively Top Measurable Outcomes (screening, vaccination & management)?

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