“Tweak Your Order Set!” Implementation of Modified Laboratory Order Set Improves Hepatitis C Virus Screening Rates in People Living With Human Immunodeficiency Virus

Wurcel, Alysse G.; Chen, Daniel D.; Chui, Kenneth K. H.; Knox, Tamsin A.

doi:10.1093/ofid/ofx098

Cited by 3 publications

(2 citation statements)

References 18 publications

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“…We plan to build from this research with continued engagement of key stakeholders and decision-makers to identify systems-based changes to increase PWID bundle uptake. Members of our research team have successfully implemented systematic interventions to increase HCV testing (Wurcel et al, 2017 ). We began working with informational technology champions to build “smart phrases” that can bring the PWID bundle into clinical notes during the sustainment phase and plan to continue to do this.…”

Section: Discussionmentioning

confidence: 99%

Implementation of a bundle to improve HIV testing during hospitalization for people who inject drugs

D. Grussing,

Pickard,

Khalid

et al. 2023

Implementation Research and Practice

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Background Increased HIV testing is essential to ending the HIV epidemic. People who inject drugs (PWID) are among the highest risk for HIV infection. Previous research at Tufts Medical Center identified low HIV testing rates in hospitalized PWID. Our research team aimed to identify and overcome barriers to inpatient HIV screening of PWID using implementation science methods. Methods Stakeholders were engaged to gather perspectives on barriers and facilitators of HIV testing. A PWID care bundle was developed and implemented, which included (1) HIV screening; (2) hepatitis A, B, and C testing and vaccination; (3) medications for opioid use disorder; and (4) naloxone prescription. Strategies from all nine Expert Recommendations for Implementing Change (ERIC) clusters guided the implementation plan. Stakeholder feedback was gathered throughout implementation, and implementation outcomes of acceptability and feasibility were assessed. Results PWID overall felt comfortable with HIV testing being offered while hospitalized. Clinicians cited that the main barriers to HIV testing were discomfort and confusion around consenting requirements. Many resident physicians surveyed reported that, at times, they forgot HIV testing for PWID. Overall, though, resident physicians felt that the PWID bundle was useful and did not distract from other patient care responsibilities. Conclusions Engagement of key stakeholders to increase HIV testing in an inpatient setting led to the implementation of a PWID bundle, which was feasible and acceptable. Bundling evidence-informed care elements for inpatient PWID should be investigated further.

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Section: Discussionmentioning

confidence: 99%

Implementation of a bundle to improve HIV testing during hospitalization for people who inject drugs

D. Grussing,

Pickard,

Khalid

et al. 2023

Implementation Research and Practice

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“…Recent studies have examined interventions to improve HCV screening among baby boomers, including provider education, electronic medical record (EMR) best practice alerts (BPAs), direct patient solicitation, and mailed outreach . Although most studies have reported that these interventions can improve HCV screening, limited research exists in racial/ethnically diverse or socioeconomically disadvantaged populations, who historically have lower HCV screening rates.…”

mentioning

confidence: 99%

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

Jain

Rich

Ahn³

et al. 2019

Hepatology

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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.

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Use of a Hepatitis C Screening Order Set to Improve Screening Rates and Measure Intervention Effectiveness

Prince

McNamara

Gondor

et al. 2019

PRiMER

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Introduction: Hepatitis C virus (HCV) infection leads to significant morbidity and mortality. Rates of HCV infection are greatest in patients born from 1945 to 1965, so the Centers for Disease Control recommends a one-time screening in this cohort. Previous interventions utilizing the electronic medical record (EMR) capabilities at two University of Utah Family Medicine clinics have increased screening rates significantly, but further improvement is possible. Methods: A family medicine resident-led continuous quality improvement (CQI) team used the Model for Improvement methods popularized by the Institute for Healthcare Improvement to create a team-based intervention with the goal of improving HCV screening in a family medicine faculty and resident clinic. An order set was created and a protocol developed that allowed medical assistants or clinic phlebotomists to order the appropriate HCV screening lab if this had not yet been done by the primary care provider. Data were extracted from the EMR that showed changes in total and monthly screening rates as well as the frequency of order set use. Results: Monthly screening rates at the Madsen Family Medicine Clinic (Salt Lake City, UT) increased from approximately 40% to greater than 50% in the 5-month intervention period. The order set was used 19 times during this period which accounted for 18.8% of new screens. Conclusions: Creating an order set that allows medical assistants to order the HCV screening lab increased HCV screening rates in our clinic. Because order set utilization data can be extracted from the EMR, this intervention provided a process measure that can differentiate the effect of this intervention from the effects of other interventions previously undertaken in the clinic.

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“Tweak Your Order Set!” Implementation of Modified Laboratory Order Set Improves Hepatitis C Virus Screening Rates in People Living With Human Immunodeficiency Virus

Cited by 3 publications

References 18 publications

Implementation of a bundle to improve HIV testing during hospitalization for people who inject drugs

Implementation of a bundle to improve HIV testing during hospitalization for people who inject drugs

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

Use of a Hepatitis C Screening Order Set to Improve Screening Rates and Measure Intervention Effectiveness

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