Strategy
Create a Continuing Medical Education (CME) program, to incentivize hospital acceptance of and participation in the Massachusetts Perinatal Hepatitis B Prevention Program (PHBPP) birth hospital visits program.
Challenge
Hepatitis B virus (HBV) infection in a pregnant person poses a serious risk to their infant. Unless they receive proper post-exposure prophylaxis (PEP), up to 90% of infants born to pregnant persons with HBV get infected, and 85% to 95% of those will become chronically infected. Up to one in four chronically infected infants will die from primary hepatocellular carcinoma (liver cancer) or cirrhosis of the liver later in life. However, transmission of HBV from gestational parent to child can be significantly reduced by quickly providing PEP to the infant at birth. PEP consists of hepatitis B immune globulin (HBIG) and the first dose of hepatitis B vaccine.
The Massachusetts Perinatal Hepatitis B Prevention Program (PHBPP), a program within the Massachusetts Immunization Division, provides case management to HBV-infected gestational parents and their infants, promoting and helping coordinate appropriate PEP, completion of the HBV vaccine series, and recommended post-vaccination serologic testing (PVST) for enrolled infants. The Massachusetts PHBPP provides case management to between 200 and 400 infected parents and their infants each year. As part of our program, nurse case managers make visits to birth hospitals to meet with key staff (i.e., nurse managers and staff in labor and delivery, postnatal, mother/baby unit).
Although the percentage of infants in Massachusetts receiving appropriate PEP remains high, we saw a slight decrease from 99.7% in the 2018 birth cohort, to 99% in the 2022 birth cohort. This period of time had multiple impacts related to the COVID-19 pandemic. At birth hospitals, we saw increased staff turnover and more difficulty scheduling education/information visits with key staff. We wanted to improve communication and staff knowledge and ensure high rates of PEP were maintained.
Solution
The department wanted to develop a CME program, to incentivize hospital acceptance of and participation in the Massachusetts PHBPP birth hospital visits program.
The program’s goals and objectives were to increase the number of birth hospital visits made each year by PHBPP nurse case managers, increase and optimize communication between key hospital staff and the PHBPP, and increase hospital staff knowledge about identifying mothers with positive labs for HBV, the clinical importance of PEP, the PHBPP, and their reporting obligations, and increase/maintain high PEP levels at birth, thereby reducing the risk of mother-to-child-transmission of
This CME program was built on the department’s existing birth hospital visiting program. The CME program was developed in 2022 and the program launched at the end of 2022. The department continued the program a second year and intend to continue it for years to come.
Costs for the CME program were minimal and included printing handouts and staff time for preparing for and providing the birth hospital visit.
The target population for the CME program were birth hospital staff responsible for newborn care, newborn immunizations, and reporting of infants born to HBV-positive gestational parents, in addition to infants born to HBV-positive gestational parents.
Outcome
The program was received well and improved collaboration between the Massachusetts Department of Public Health, PHBPP, and the birth hospitals, which will ultimately foster optimal program and health outcomes. Another significant outcome of the program was that a major urban hospital developed an electronic health record (EHR) enhancement of an automatic pop up reminding the clinician to submit a reporting form to the state and a direct link to the online report.
The department hopes other hospitals, especially within that system, will replicate this. The team was asked to speak about this program at the August 2024 PHBPP Reverse Site Visit at CDC. As a result of the presentation, the team offered an ad-hoc breakout which was well attended and have had multiple requests for more information. The team is working on providing program information and content to all PHBPP jurisdictions via the CDC PHBPP. This program is very replicable, either as birth hospital visits alone, or with the offer of CME. This program is also easily adaptable to include education/information on RSV immunization for pregnant persons and infants, and VFC enrollment.
The CME application process was done in 2022 after developing the program. The first program ran November 2022-October In the first program year, 12% of birth hospitals in the jurisdiction were visited. The CME application was approved for a second year, which is nearing completion. The program will be applying to continue the process for coming years. The next goal is to be able to visit 25% of jurisdictional birth hospitals each year.
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