2019 HSR&D/QUERI National Conference

4028 — Using the EHR to Assess the Feasibility of Expanded TB Screening in the Veteran's Health Administration

Lead/Presenter: Hannah Gelman,  COIN - Seattle/Denver
All Authors: Gelman H (Veterans Administration (VA) Center of Innovation for Veteran-Centered and Value-Driven Care), Thanassi W (VA Palo Alto Health Care System, Stanford Hospital and Medical Center), Zeliadt S (VA Center of Innovation for Veteran-Centered and Value-Driven Care, University of Washington) Winston C (Division of Tuberculosis Elimination, Centers for Disease Control and Prevention)

We used electronic health records (EHR) in the Veteran's Health Administration (VA) to assess the 2016 US Preventative Services Task Force (USPSTF) recommendation for universal TB screening of patients with elevated risk for TB exposure. We identified two cohorts of patients with elevated risk - those born outside the United States newly entering care in the VA and patients documented as exposed to TB.

VA's EHR was queried to identify patients meeting elevated risk criteria between 2007-2017. Testing for tuberculosis infection was identified when it followed the patient's first visit in the VA for the non-US born cohort or after documentation of exposure to TB. Testing data included fourteen ICD9/10 and CPT/HCPCS codes. Pharmacy data, laboratory tests, medical records, and skin test order histories were also interrogated.

We found that 19,976 of 190,892 (10.5%) of newly enrolled non-US born patients received a test for tuberculosis infection within the VA health system after their initial visit. Testing prevalence in the non-US born cohort was found to be much lower than that found for the patients recorded as exposed to TB (56.5% with documented testing).

The 2016 USPTF recommendations for TB testing of at-risk populations acknowledged that current testing prevalence in these populations is unknown. Here, we have provided the first analysis of the gap between current practice and these recommendations. We find that a majority of patients in the VA at risk due to birth outside the United States are not being tested for TB.

Ensuring that at-risk patients are identified, tested and, if positive, treated for latent TB infection to prevent progression to TB disease has the potential to help eliminate TB in the US. Given the large gap we observe in screening of at-risk patients, it may be necessary for the VA to develop and track a quality measure of appropriate TB testing of at-risk patients to make progress towards implementing this USPSTF recommendation and eliminating TB among VA patients.