Hepatitis C: improving the quality of screening in a community hospital by implementing an electronic medical record intervention

Abstract

Both the Centers for Disease Control and Prevention (CDC) and the U.S. Preventive Services Task Force (USPSTF) have recommended that adults born between the years of 1945-1965 should receive one-time testing for Hepatitis C Virus (HCV). In fact, Governor Andrew Cuomo of the State of New York had signed a bill on October 23, 2013 which mandated NY hospitals and healthcare providers to offer HCV testing to all “Baby Boomers.” For our project, we wanted to increase our community hospital's compliance with this law and improve the quality of patient care in doing so.An electronic medical record intervention was implemented in conjunction with our information technology services department. This intervention would flag eligible patients and would run them through a predetermined algorithm to see if they needed HCV testing. Multiple plan, do, study, act (PDSA) cycles were run during the length of the study and many changes were made in order to achieve maximum effect.We ended up increasing our HCV testing rate from 47.2% (pre-intervention) to 87.9% (final month of the study), which was statistically significant with a p-value of <0.0000001. We also ended up with a framework that is both generalizable to other projects and is also self-sustaining, so that it can continue to run itself once all the project members have finished working there as house staff.

Impact of electronic reminder systems on hepatitis C screening in primary care

“…Our finding of a screening rate, in response to the EMR reminder, of 37%, is within the range of HCV testing frequency reported in other studies with EMR‐based prompts, which have ranged from 30% to 88% . It should be noted that our centre did not initiate a specific training programme, making the implementation of this approach very simple.…”

“…Our finding of a screening rate, in response to the EMR reminder, of 37%, is within the range of HCV testing frequency reported in other studies with EMR-based prompts, which have ranged from 30% to 88%. 6,10,15,16 It should be noted that our centre did not initiate a specific training programme, making the implementation of this approach very simple. Brady et al compared, in 3 medical systems, the effect of a mailed patient reminder, an EMR-based alert and direct patient solicitation at the time of a visit, and found all 3 approaches to increase testing dramatically over baseline.…”

“…In another urban medical centre setting, an educational programme targeted at internal medicine residents led to over 2800 baby boomers screened for HCV over a 1‐year period, with a diagnostic yield of approximately 4% for HCV infection, and 80% of infected patients subsequently seen by specialists . Electronic medical record (EMR) reminders for HCV screening have been shown to double or quadruple screening rates . Less is known about the effectiveness of EMR‐based HCV screening programmes outside of urban centres and to what extent positive cases are referred for specialty treatment.…”

“…9 Electronic medical record (EMR) reminders for HCV screening have been shown to double or quadruple screening rates. 6,10 Less is known about the effectiveness of EMR-based HCV screening programmes outside of urban centres and to what extent positive cases are referred for specialty treatment.…”

Hepatitis C test uptake among historic blood transfusion recipients following media coverage of the Penrose Inquiry and an awareness‐raising campaign

“…A growing body of evidence has demonstrated that electronic clinical reminders in patient management system can increase HCV test uptake and case‐finding and again, this could be used to flag individuals who may have had a blood transfusion . While less established, opt‐out testing in primary care has also been demonstrated to increase HCV testing in primary care …”