Journal of clinical gastroenterology · 2026
A Quality Improvement Initiative to Increase Helicobacter pylori Testing and Eradication Among Patients Diagnosed With Peptic Ulcer Disease in a U.S. Safety-Net Hospital.
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Abdel-Jaber Wesam, Padilla Fernando, Gomez Cifuentes Juan D, Agrawal Neeraj, Sealock Robert J, El-Serag Hashem B, Tan Mimi C
Аннотация
BACKGROUND: Helicobacter pylori infection is the primary risk factor for peptic ulcer disease (PUD). Given rising antibiotic resistance, optimizing treatment and eradication remain paramount. We evaluated whether an educational intervention and an electronic medical record (EMR) bioinformatic intervention improved rates of H. pylori testing, treatment, and eradication testing in patients diagnosed with PUD in a safety-net hospital.
METHODS: We examined potential gaps in H. pylori testing and treatment using a fishbone diagram and impact-effort matrix analyses. The first educational intervention consisted of multilingual educational templates for patients and providers on H. pylori testing and treatment. Second, we developed an EMR SmartSet order set to facilitate optimal antibiotic treatment and eradication testing. We determined rates of H. pylori testing, treatment, and eradication in preintervention (8/2020 to 2/2021), first postintervention (5/2021 to 3/2022), and second postintervention groups (7/2022 to 12/2022).
RESULTS: Among 351 patients with PUD, rates of H. pylori testing remained consistent across the preintervention, first postintervention, and second postintervention groups (mean 93.2%). Rates of optimal treatment (defined as bismuth-quadruple, clarithromycin-quadruple, or rifabutin-triple therapy with a proton pump inhibitor for 14 d) increased from 22.7% preintervention to 66.0% in the second postintervention group (P=0.001). Post-treatment eradication testing among infected patients increased from 49.7% to 60.3% in the second postintervention group (P=0.583), and confirmed H. pylori eradication improved from 59% to 63% in the second postintervention group (P=0.950).
CONCLUSIONS: An educational intervention and an EMR order set significantly increased rates of optimal, evidence-based treatment of H. pylori among PUD patients and modestly improved post-treatment eradication testing and confirmed eradication.
METHODS: We examined potential gaps in H. pylori testing and treatment using a fishbone diagram and impact-effort matrix analyses. The first educational intervention consisted of multilingual educational templates for patients and providers on H. pylori testing and treatment. Second, we developed an EMR SmartSet order set to facilitate optimal antibiotic treatment and eradication testing. We determined rates of H. pylori testing, treatment, and eradication in preintervention (8/2020 to 2/2021), first postintervention (5/2021 to 3/2022), and second postintervention groups (7/2022 to 12/2022).
RESULTS: Among 351 patients with PUD, rates of H. pylori testing remained consistent across the preintervention, first postintervention, and second postintervention groups (mean 93.2%). Rates of optimal treatment (defined as bismuth-quadruple, clarithromycin-quadruple, or rifabutin-triple therapy with a proton pump inhibitor for 14 d) increased from 22.7% preintervention to 66.0% in the second postintervention group (P=0.001). Post-treatment eradication testing among infected patients increased from 49.7% to 60.3% in the second postintervention group (P=0.583), and confirmed H. pylori eradication improved from 59% to 63% in the second postintervention group (P=0.950).
CONCLUSIONS: An educational intervention and an EMR order set significantly increased rates of optimal, evidence-based treatment of H. pylori among PUD patients and modestly improved post-treatment eradication testing and confirmed eradication.