Evaluation of a Multifaceted Intervention to Reduce Health Disparities in Hepatitis C Screening: A Pre‐Post Analysis

Abstract

Hepatitis C virus (HCV) testing in persons born from 1945 to 1965 has had limited adoption despite guidelines, particularly among racial/ethnic minorities and socioeconomically disadvantaged patients, who have a higher prevalence of disease burden. We examined the effectiveness of a multifaceted intervention to improve HCV screening in a large safety‐net health system. We performed a multifaceted intervention that included provider and patient education, an electronic medical record–enabled best practice alert, and increased HCV treatment capacity. We characterized HCV screening completion before and after the intervention. To identify correlates of HCV screening, we performed logistic regression for the preintervention and postintervention groups and used a generalized linear mixed model for patients observed in both preintervention and postintervention time frames. Before the intervention, 10.1% of 48,755 eligible baby boomer patients were screened. After the intervention, 34.6% of the 34,093 eligible baby boomers were screened (P < 0.0001). Prior to the intervention, HCV screening was lower among older baby boomers and providers with large patient panels and higher in high‐risk subgroups including those with signs of liver disease (e.g., elevated transaminases, thrombocytopenia), human immunodeficiency virus–positive patients, and homeless patients. Postintervention, we observed increased screening uptake in older baby boomers, providers with larger patient panel size, and patients with more than one prior primary care appointment. Conclusion: Our multifaceted intervention significantly increased HCV screening, particularly among older patients, those engaged in primary care, and providers with large patient panels.

Patient and provider‐level barriers to hepatitis C screening and linkage to care: A mixed‐methods evaluation

“…Our evaluation provides insight into guideline implementation in large healthcare systems, even as guidelines ostensibly simplify recommendations and processes of care. Despite engagement with institutional leadership that resulted in fivefold increases in screening and treatment capacity, 3 clinic providers and patients identified continued barriers to HCV screening and linkage to care in clinical practice. For example, provider interviews revealed ongoing need for education to inform providers about coverage for HCV treatment cost during conversations with patients about HCV screening.…”

“…Second, hepatology and infectious disease specialists performed provider‐level education through in‐clinic forums for primary care providers (PCPs) and staff. Finally, we conducted patient‐level telephone outreach and navigation for linkage‐to‐treatment evaluation 3 . The intervention was developed following stakeholder engagement with the Medical Directors of the adult ambulatory care, primary care and hepatology clinics, in consultation with the Parkland Chief Executive Officer and Chief Medical Officer.…”

“…The purpose of this paper was to describe a mixed‐method, multi‐modal evaluation of the evidence‐based HCV intervention. We have previously reported both screening and linkage‐to‐care significantly increased after the HCV intervention was implemented; however, over two‐thirds of patients still failed to undergo HCV screening and one‐third with confirmed HCV infection were not linked to treatment evaluation, suggesting continued barriers to guideline implementation in clinical practice 3 . Herein, we sought patient and provider experiences to identify ongoing barriers to adoption and implementation processes at the system‐, provider‐ and patient‐level across the HCV screening and treatment evaluation continuum.…”

External validation of LCR1-LCR2, a multivariable HCC risk calculator, in patients with chronic HCV

“…M.Sc., 3 Olivier Deckmyn M.Sc., 4 Valentina Peta, Ph.D., 2,4 Sepideh Akhavan M.D. M.Sc., 1 Victor de Ledinghen M.D., Ph.D., 5 Fabien Zoulim M.D., Ph.D., 6 Didier Samuel M.D., Ph.D., 7 Philippe Mathurin M.D., Ph.D., 8 Vlad Ratziu M.D., Ph.D. 1,2 Dominique Thabut M.D., Ph.D. 1,2 , Chantal Housset M.D., Ph.D. 2 , Hélène Fontaine M.D., Ph.D. 9 , Stanislas Pol M.D., Ph.D. 9 , Fabrice Carrat M.D., Ph.D., 3 for the HECAM consortium and the ANRS CO22 Hepather cohort*.…”

“…In western countries, Egypt, and Japan, the main cause of HCC is HCV infection. Despite screening of baby-boomers, 5 , 6 as well as the efficacy of direct-acting antivirals (DAA) on necroinflammatory activity, the progression of fibrosis, and occurrence of HCC, [7] , [8] , [9] the effectiveness of surveillance remains a matter of debate. 1 , 3 , 4 The American Association for the Study of Liver Diseases only recommends surveillance every 6 months in patients with cirrhosis, based on ultrasound with or without serum alpha-fetoprotein (AFP), defined here as ‘standard surveillance’.…”