Results of a Rapid Hepatitis C Virus Screening and Diagnostic Testing Program in an Urban Emergency Department

White, Douglas A.E.; Anderson, Eric G.; Pfeil, Sarah K.; Trivedi, Tarak; Alter, Harrison J.

doi:10.1016/j.annemergmed.2015.06.023

Cited by 67 publications

(78 citation statements)

References 12 publications

(18 reference statements)

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“…The majority of patients with positive screening did not link to care in our referral system. This finding is consistent with a recent report by White et al [11], in which 23% of individuals (baby boomers and intravenous drug users) successfully attended HCV care visit within 6 months of ED diagnosis. In our cohort, 25% of patients who achieved LTC (83 of 332) did so in the first 6 months of follow up.…”

Section: Discussionsupporting

confidence: 93%

Characterizing Failure to Establish Hepatitis C Care of Baby Boomers Diagnosed in the Emergency Department

Franco

Overton

Tamhane

et al. 2016

Open Forum Infectious Diseases

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Background.Emergency departments (EDs) are high-yield sites for hepatitis C virus (HCV) screening, but data regarding linkage to care (LTC) determinants are limited.Methods.Between September 2013 and June 2014, 4371 baby boomers unaware of their HCV status presented to the University of Alabama at Birmingham ED and underwent opt-out screening. A linkage coordinator facilitated referrals for positive cases. Demographic data, International Classification of Diseases, Ninth Revision codes, and clinic visits were collected, and patients were (retrospectively) followed up until February 2015. Linkage to care was defined as an HCV clinic visit within the hospital system.Results.Overall, 332 baby boomers had reactive HCV antibody and detectable plasma ribonucleic acid. The mean age was 57.3 years (standard deviation = 4.8); 70% were male and 61% were African Americans. Substance abuse (37%) and psychiatric diagnoses (30%) were prevalent; 9% were identified with cirrhosis. During a median follow-up of 433 days (interquartile range, 354–500), 117 (35%) linked to care and 48% needed inpatient care. In multivariable analysis, the odds of LTC failure were significantly higher for white males (adjusted odds ratio [aOR], 2.57; 95% confidence interval [CI], 1.03–6.38) and uninsured individuals (aOR, 5.16; 95% CI, 1.43–18.63) and lower for patients with cirrhosis (aOR, 0.36; 95% CI, 0.14–0.92) and access to primary care (aOR, 0.20; 95% CI, 0.10–0.41).Conclusions.In this cohort of baby boomers with newly diagnosed HCV in the ED, only 1 in 3 were linked to HCV care. Although awareness of HCV diagnosis remains important, intensive strategies to improve LTC and access to curative therapy for diagnosed individuals are needed.

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Section: Discussionsupporting

confidence: 93%

Characterizing Failure to Establish Hepatitis C Care of Baby Boomers Diagnosed in the Emergency Department

Franco

Overton

Tamhane

et al. 2016

Open Forum Infectious Diseases

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“…Before this work, observational studies suggested that EHR-directed testing was a promising strategy even though these studies could not fully determine the impact of EHR-based testing. 4,23–25 White et al 23 reported the results of HCV testing in an emergency department in which a triage nurse offered HCV testing to patients with history of injection drug use or who were born between 1945 and 1964 when prompted by an EHR-based alert. Approximately half of age-eligible patients were offered HCV testing and 29% of them received testing, among whom 11% were positive.…”

Section: Discussionmentioning

confidence: 99%

An Electronic Health Record–based Intervention to Promote Hepatitis C Virus Testing Among Adults Born Between 1945 and 1965

et al. 2017

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Background The Centers for Disease Control and Prevention (CDC) recommends one-time hepatitis C virus (HCV) antibody testing for “Birth Cohort” adults born during 1945–1965. Objective To examine the impact of an electronic health record (EHR)-embedded best practice alert (BPA) for HCV testing among Birth Cohort adults. Design Cluster-randomized trial was conducted from April 29, 2013 to March 29, 2014. Subjects and Setting Ten community and hospital-based primary care practices. Participants were attending physicians and medical residents during 25,620 study-eligible visits. Intervention Physicians in all practices received a brief introduction to the CDC testing recommendations. At visits for eligible patients at intervention sites, physicians received a BPA through the EHR to order HCV testing or medical assistants were prompted to post a testing order for the physician. Physicians in control sites did not receive the BPA. Main Outcomes HCV testing; the incidence of HCV antibody positive tests was a secondary outcome. Results Testing rates were greater among Birth Cohort patients in intervention sites (20.2% vs. 1.8%, P < 0.0001) and the odds of testing were greater in intervention sites after controlling for imbalances of patient and visit characteristics between comparison groups [odds ratio (OR), 9.0; 95% confidence interval, 7.6–10.7). The adjusted OR of identifying HCV antibody positive patients was also greater in intervention sites (OR, 2.1; 95% confidence interval, 1.3–11.2). Conclusions An EHR-embedded BPA markedly increased HCV testing among Birth Cohort patients, but the majority of eligible patients did not receive testing indicating a need for more effective methods to promote uptake.

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“…EDs have consistently been identified as a ‘safety net’ of care for patients, serving as their gateway to further health services 7,8 . The ED patient population has also been associated with a higher burden of HCV infection when compared to the general population in both the United States and Canada 9‐11 . Screening initiatives within EDs have been associated with detection of newly diagnosed infections and an increase in the number of patients who are linked to timely care 12‐14 .…”

Section: Introductionmentioning

confidence: 99%

The emergency department as a setting‐specific opportunity for population‐based hepatitis C screening: An economic evaluation

Mendlowitz

Naimark

Wong

et al. 2020

Liver International

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Background and Aims:The World Health Organization's hepatitis C virus (HCV) elimination strategy recognizes the need for interventions that identify populations most affected by infection. The emergency department (ED) has been suggested as a setting for HCV screening. The study objective was to explore the health and economic impact of HCV screening in the ED setting. Methods:We used a microsimulation model to conduct a cost-utility analysis evaluating two ED setting-specific strategies: no screening, and screening and subsequent treatment. Strategies were examined for two populations: (a) the general ED patient population; and (b) ED patients born between 1945 and 1975. The analysis was conducted from a healthcare payer perspective over a lifetime time horizon. A reference and high ED HCV seroprevalence measure were examined in the Canadian healthcare setting.US costs of chronic infection were used for a scenario analysis of screening in the US healthcare setting. Results: For birth cohort screening, in comparison to no screening, one liver-related death was averted for every 760 and 123 persons screened for the reference and high seroprevalence measures. For general population screening, one liver-related death was averted for every 831 and 147 persons screened for the reference and high seroprevalence measures. In comparison to no screening, birth cohort screening was cost-effective at CAN$25,584/quality-adjusted life year (QALY) and US$42,615/QALY. General population screening was cost-effective at CAN$19,733/QALY and US$32,187/QALY. Conclusions: ED screening may represent a cost-effective component of populationbased strategies to eliminate HCV. Further studies are warranted to explore the feasibility and acceptability of this approach. K E Y W O R D S cost-utility analysis, economic evaluation, emergency department, hepatitis C, screening | 1283 MENDLOWITZ ET aL.

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Results of a Rapid Hepatitis C Virus Screening and Diagnostic Testing Program in an Urban Emergency Department

Cited by 67 publications

References 12 publications

Characterizing Failure to Establish Hepatitis C Care of Baby Boomers Diagnosed in the Emergency Department

Characterizing Failure to Establish Hepatitis C Care of Baby Boomers Diagnosed in the Emergency Department

An Electronic Health Record–based Intervention to Promote Hepatitis C Virus Testing Among Adults Born Between 1945 and 1965

The emergency department as a setting‐specific opportunity for population‐based hepatitis C screening: An economic evaluation

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