From the 2019 HVPAA National Conference
Dr. Mohamed Zakarya (The Stamford Hospital/Columbia University Vagelos College of Physicians and Surgeons), Dr. Alex Pose (Optimus Health Care), Ms. Tizita Fekredengel (Optimus Health Care), Dr. Forugh Homayounrooz (The Stamford Hospital/Columbia University Vagelos College of Physicians and Surgeons)
Background
Hepatitis C virus (HCV) is the most common chronic blood-borne pathogen in the United States (U.S.). Treatments for HCV are curative, of short duration, and have few associated side effects, increasing the importance of identifying HCV-infected individuals. Screening guidelines for persons at high risk are published by various expert and public health organizations, and these include a 1-time screening for individuals born between 1945 and 1965 (baby boomers). Baby boomers have a fivefold higher risk of HCV infection and the highest risk for HCV-related morbidity and mortality. A recent study noted that baby boomers represent more than 75% of HCV-positive individuals in the U.S. Nevertheless, as of 2015, less than 13% of baby boomers in the U.S. have undergone screening for HCV infection.
Objective
This is a preliminary study aiming at quantifying the baseline HCV screening rates amongst baby boomers in our residents’ clinic, and developing resident-targeted interventions in order to improve the screening rates leading to early detection and treatment for better outcomes for both patients and healthcare system.
Methods
A retrospective chart review of patients born during 1945-1965 and seen by medical residents between July 1st, 2017 and December 31st, 2018 was performed. Patients had to be seen at least once for a physical exam by the medical resident. Patients were classified as unscreened, true negative (“TN”, patients with non-reactive HCV antibody), false positive (“FP”, patients with reactive HCV antibody but undetected HCV RNA), or true positive (“TP”, patients with reactive HCV antibody and detected HCV RNA).
Results
From July 1st, 2017 through December 31st, 2018, 502 patients met criteria. Of them, 413 (82.3%) were unscreened and 89 (17.7%) were appropriately screened; 76 (85.4%) tested TN, 13 (14.6%) tested FP, and none tested TP.
Conclusion
This investigation shows the suboptimal rate of screening for HCV in baby boomers in our residents’ clinic. Our findings highlight the need for an effective strategy and a feasible intervention for improving HCV screening at the medical resident’s clinic. Several initiatives are taken in order to develop and integrate appropriate tools into our clinic infrastructure. This includes an updated electronic medical record (EMR) reminder for screening based on gender and birth year, HCV risk assessment tool for medical staff to identify patients need testing before visit, a link to HCV screening indications and protocol, and extensive education to physicians and trainees about testing, reporting, tracking, and linking patients to appropriate posttest care. In addition, informational posters about HCV risk factors, populations at risk, and who should be screened are now posted for patients’ education. Evaluation of these interventions will follow a 6-month period of implementation.
Clinical Implications
In economic models and in real-world practice, studies have shown that identifying patients with hepatitis C infection and linking them to early treatment provides good value for our health care dollar and proves to be cost-effective and even cost-saving in some venues. Therefore, screening baby boomers for HCV infection can help identify individuals who are in need for medical attention as well as limit the continuous cycle of HCV infection in our society.
