{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T15:31:59Z","timestamp":1784129519232,"version":"3.55.0"},"reference-count":13,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000871","name":"mayo clinic","doi-asserted-by":"publisher","award":["30020219"],"award-info":[{"award-number":["30020219"]}],"id":[{"id":"10.13039\/100000871","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Prim Care Community Health"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Adult hepatitis B vaccination coverage in the United States remains low despite updated national recommendations supporting universal adult immunization. Many adults remain unaware of their susceptibility to hepatitis B virus (HBV) infection. This quality improvement (QI) study evaluated a stepwise \u201cOffer\u2013Offer\u2013Test\u2013Vaccinate\u201d workflow designed to improve hepatitis B vaccine uptake among vaccine-hesitant adults in a primary care setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This retrospective QI study was conducted at a single primary care clinic in Rochester, Minnesota. Adult patients (\u226519 years) seen between October 1, 2022, and October 1, 2024, were routinely offered hepatitis B vaccination during rooming. Two participating physicians implemented an enhanced workflow in which patients who declined vaccination were counseled and then offered serologic screening using the 2023 CDC-recommended triple panel (HBsAg, anti-HBs, and total anti-HBc). Patients with negative serology were notified via the patient portal and reoffered vaccination along with a link to the CDC Vaccine Information Statement. The primary endpoint was initiation of the hepatitis B vaccine series following receipt of negative serology results. Preliminary series-completion data through October 1, 2025, were also assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Among 501 eligible adults, 104 (20.8%) accepted vaccination at the initial offer. Of the 397 who declined, 106 (26.7%) agreed to serologic testing; 91 (85.8%) were seronegative. Among seronegative patients, 41 (45.1%) subsequently accepted vaccination. Integrating serologic testing increased overall vaccination uptake from 20.8% to 28.9%, an absolute increase of 8.2 percentage points and a relative increase of 39.4%. Approximately 2.6 serologic tests were required to generate 1 additional first-dose vaccination. Preliminary series-completion rates were 74.0% among those vaccinated at the initial offer and 87.8% among those vaccinated following serologic testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion:<\/jats:title>\n                    <jats:p>In this primary care setting, incorporating serologic testing into the workflow was associated with modestly improved hepatitis B vaccination uptake among vaccine-hesitant adults. Serologic results may help re-engage patients by providing personalized immunity information. Implementation considerations include staffing needs, laboratory access, patient portal engagement, and insurance coverage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The \u201cOffer\u2013Offer\u2013Test\u2013Vaccinate\u201d strategy was associated with a modest increase in hepatitis B vaccine uptake among hesitant adults. This EMR-integrated, stepwise approach may offer a feasible and scalable strategy to reduce missed vaccination opportunities and support HBV prevention in adult primary care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21501319251408993","type":"journal-article","created":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T06:57:53Z","timestamp":1766473073000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["A Strategy to Improve Hepatitis B Vaccine Uptake in Hesitant Adults: The Offer\u2013Offer\u2013Test\u2013Vaccinate Approach"],"prefix":"10.1177","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-7166-4579","authenticated-orcid":false,"given":"Laura","family":"Wangensteen","sequence":"first","affiliation":[{"name":"Mayo Clinic, Rochester, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1163-4628","authenticated-orcid":false,"given":"Fahma","family":"Mohamed","sequence":"additional","affiliation":[{"name":"Mayo Clinic, Rochester, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4055-297X","authenticated-orcid":false,"given":"Sara S.","family":"Oberhelman-Eaton","sequence":"additional","affiliation":[{"name":"Mayo Clinic, Rochester, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2765-7336","authenticated-orcid":false,"given":"Natalie M.","family":"Averkamp","sequence":"additional","affiliation":[{"name":"Mayo Clinic College of Medicine, Rochester, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-7866-7515","authenticated-orcid":false,"given":"Jack A.","family":"Kiernan","sequence":"additional","affiliation":[{"name":"Mayo Clinic College of Medicine, Rochester, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7340-508X","authenticated-orcid":false,"given":"Roshini I.","family":"Selladurai","sequence":"additional","affiliation":[{"name":"Mayo Clinic, Rochester, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-0410-5995","authenticated-orcid":false,"given":"Bradley A.","family":"Bohn","sequence":"additional","affiliation":[{"name":"Mayo Clinic, Rochester, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6467-6179","authenticated-orcid":false,"given":"Benjamin","family":"Lai","sequence":"additional","affiliation":[{"name":"Mayo Clinic, Rochester, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0541-7265","authenticated-orcid":false,"given":"Jason","family":"O\u2019Grady","sequence":"additional","affiliation":[{"name":"Mayo Clinic, Rochester, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,12,22]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.4551"},{"key":"e_1_3_3_3_2","unstructured":"Ferlay J Ervik M Lam F et al. Global Cancer Observatory: Cancer Today. International Agency for Research on Cancer. 2025. Accessed April 19 2025. https:\/\/gco.iarc.who.int\/today"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/hep.31288"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1002\/hep.31991"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1002\/hep.31782"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1111\/jvh.13060"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.3390\/vaccines12040439"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.rr7201a1"},{"key":"e_1_3_3_10_2","unstructured":"Centers for Disease Control and Prevention. Vaccination coverage among adults in the United States National Health Interview Survey 2021. July 19 2024. Accessed October 28 2025. https:\/\/www.cdc.gov\/adultvaxview\/publications-resources\/vaccination-coverage-adults-2021.html"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1086\/653622"},{"key":"e_1_3_3_12_2","unstructured":"Centers for Disease Control and Prevention. Viral Hepatitis Surveillance Report \u2014 United States 2021. August 7 2023. Accessed October 30 2025. https:\/\/www.cdc.gov\/hepatitis-surveillance-2021\/index.html"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7338a3"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7113a1"}],"container-title":["Journal of Primary Care &amp; Community Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/21501319251408993","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/21501319251408993","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/21501319251408993","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:23:46Z","timestamp":1777508626000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/21501319251408993"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12]]},"references-count":13,"alternative-id":["10.1177\/21501319251408993"],"URL":"https:\/\/doi.org\/10.1177\/21501319251408993","relation":{},"ISSN":["2150-1319","2150-1327"],"issn-type":[{"value":"2150-1319","type":"print"},{"value":"2150-1327","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12]]},"article-number":"21501319251408993"}}