Although injection drug use (IDU) and blood transfusions prior to 1992 are well-accepted risk factors for hepatitis C virus (HCV) infection, many studies that evaluated tattooing as a risk factor for HCV infection did not control for a history of IDU or transfusion prior to 1992. In this large, multicenter, case-control study, we analyzed demographic and HCV risk factor exposure history data from 3,871 patients, including 1,930 with chronic HCV infection (HCV RNA-positive) and 1,941 HCV-negative (HCV antibody-negative) controls. Crude and fully adjusted odds ratios (ORs) of tattoo exposure by multivariate logistic regression in HCV-infected versus controls were determined. As expected, IDU (65.9% versus 17.8%; P < 0.001), blood transfusion prior to 1992 (22.3% versus 11.1%; P < 0.001), and history of having one or more tattoos (OR, 3.81; 95% CI, 3.23-4.49; P < 0.001) were more common in HCV-infected patients than in control subjects. After excluding all patients with a history of ever injecting drugs and those who had a blood transfusion prior to 1992, a total of 1,886 subjects remained for analysis (465 HCV-positive patients and 1,421 controls). Among these individuals without traditional risk factors, HCV-positive patients remained significantly more likely to have a history of one or more tattoos after adjustment for age, sex, and race/ethnicity (OR, 5.17; 95% CI, 3.75-7.11; P < 0.001). Conclusion: Tattooing is associated with HCV infection, even among those without traditional HCV risk factors such as IDU and blood transfusion prior to 1992. (HEPATOLOGY 2013;57:2117-2123 As new and better medications for the treatment of HCV become available, [13][14][15] measures to increase detection rates and engagement in care are paramount. In the last decade, an expanding body of research has emerged, evaluating both traditional and nontraditional risk factors for HCV infection in an effort to increase the yield from costly yet potentially life-saving screening efforts. 7,[16][17][18][19] Most recently, the US Department of Health and Human Services issued an action plan for the prevention, care, and treatment of viral hepatitis, setting goals to increase the proportion of persons who are aware of their HCV infection from 45% to 66%, and to reduce the number of new cases of HCV infection by 25%. 20In contrast to the overwhelming evidence implicating IDU in HCV acquisition, the association between HCV transmission and other suspected risk factors such as tattooing is more controversial. Although some studies have demonstrated an association between tattoos and HCV infection, others have not.21 Prior studies that examined tattooing behavior and HCV

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Background To create meaningful quality improvement (QI) curricula for graduate medical education (GME) trainees, institutions strive to improve coordination of QI curricula with hospital improvement infrastructure. Objective We created a curriculum to teach residents about QI and value-based medicine (VBM) and assessed curricular effectiveness. Methods We designed a 2-week required curriculum for internal medicine residents at a large academic program. After participating in basic skills workshops, trainees developed QI/VBM project ideas with faculty and nonclinical support and pitched them to hospital leaders at the end of the rotation. Pre-post and 1-year follow-up surveys were conducted for residents to self-assess knowledge, attitudes, and skills, participation in QI/VBM projects, and career intentions. We tracked QI/VBM project implementation. Results In the first 2 years (2017–2018), 92 trainees participated, and 71 of 76 (93%) recommended the curriculum. Surveys (76 of 92, 83%) show improvement in our learning objectives (12%–60% pre to 62%–97% post; P < .001 for all; Cohen's d effect size 0.7–1.2), which are sustained at 1-year follow-up (57%–95%; P < .01). Four of 19 projects have been implemented. At 1 year, 95% of residents had presented a quality/value poster presentation, 44% were involved in QI/VBM beyond required rotations, and 26% plan to pursue careers focused on improving quality, safety, or value. Conclusions Our project-based curriculum culminating in a project pitch to hospital leadership was acceptable to GME trainees, improved self-assessed skills sustained at 1 year, and resulted in successfully implemented QI/VBM projects.