Implementation of a Large System-Wide Hepatitis C Virus Screening and Linkage to Care Program for Baby Boomers

Abstract

BackgroundWe implemented and evaluated a large health system-wide hepatitis C virus (HCV) screening and linkage to care program for persons born between 1945 and 1965 (“baby boomers”).MethodsAn electronic health record (EHR) clinical decision support (CDS) tool for HCV screening for baby boomers was introduced in August 2015 for patients seen in the outpatient University of California, Los Angeles healthcare system setting. An HCV care coordinator was introduced in January 2016 to facilitate linkage to HCV care. We compared HCV testing in the year prior (August 2014–July 2015) to the year after (August 2015–July 2016) implementation of the CDS tool. Among patients with reactive HCV antibody testing, we compared outcomes related to the care cascade including HCV ribonucleic acid (RNA) testing, HCV RNA positivity, and linkage to HCV specialty care.ResultsDuring the study period, 19606 participants were screened for HCV antibody. Hepatitis C virus antibody screening increased 145% (from 5676 patients tested to 13930 tested) after introduction of the CDS intervention. Screening increased across all demographic groups including age, sex, and race/ethnicity, with the greatest increases among those in the older age groups. The addition of an HCV care coordinator increased follow-up HCV RNA testing for HCV antibody positive patients from 83% to 95%. Ninety-four percent of HCV RNA positive patients were linked to care postimplementation.ConclusionsIntroduction of an EHR CDS tool and care coordination markedly increased the number of baby boomers screened for HCV, rates of follow-up HCV RNA testing, and linkage to specialty HCV care for patients with chronic HCV infection.

Toward the elimination of hepatitis C in the United States

“…A positive antibody test is followed by HCV RNA testing by polymerase chain reaction that confirms an infection and quantifies the viral load. Both of these tests have been used widely for HCV diagnosis in many different health systems in developed countries . Point‐of‐care HCV testing using fingerstick blood, such as OraQuick HCV Rapid Antibody Test (manufactured by OraSure Technologies, Bethlehem, Pennsylvania), is also available and has comparable sensitivity and specificity to that of the HCV enzyme‐linked immunosorbent assay test .…”

“…To address this gap, University of California Los Angeles Health has implemented electronic health record HCV screening reminders and used a nonclinically trained patient care coordinator to facilitate both follow‐up HCV RNA testing and linkage to care. After implementation of the program, HCV screening increased by 145% . HCV antibody‐positive patients who received HCV RNA testing also increased from 83% to 95% ( P < 0.01), and the percentage of patients who attended their initial appointment with a specialist increased from 88% to 94%.…”

“…The emergency room has been proposed as another possible point for screening as the addition of HCV screening did not increase the emergency room length of stay when there were other laboratory tests involved . The use of an electronic HCV screening reminder in existing electronic health medical records has been shown to increase the number of screening tests by 145% in a large academic health care system . Family physicians and nurse practitioners were able to achieve similar SVR rates to those of a specialist with DAAs after 3 hours of guideline‐based training .…”

“…After implementation of the program, HCV screening increased by 145%. (17) HCV antibody-positive patients who received HCV RNA testing also increased from 83% to 95% (P < 0.01), and the percentage of patients who attended their initial appointment with a specialist increased from 88% to 94%. The results of the study highlight the role of a coordinator to help bridge the gap from diagnosis to eventual potential treatment.…”

“…Both of these tests have been used widely for HCV diagnosis in many different health systems in developed countries. (17) Point-of-care HCV testing using fingerstick blood, such as OraQuick HCV Rapid Antibody Test (manufactured by OraSure Technologies, Bethlehem, Pennsylvania), is also available and has comparable sensitivity and specificity to that of the HCV enzyme-linked immunosorbent assay test. (18,19) Such tests may be helpful in using limited resources to screen large groups of individuals.…”