From the 2018 HVPAA National Conference
Kevin Harris (Cleveland Clinic), Adam Kichler (Cleveland Clinic), Richard Cartabuke (Cleveland Clinic)
At our institution, none of the patients referred to hepatology for HCV treatment have undergone the requisite evaluations necessary to develop a HCV directed care plan. As a result, there are delays in the development of a treatment plan, increases in healthcare costs, and declines in patient and provider satisfaction.
Our objective was to optimize initial subspecialty patient encounters in individuals newly diagnosed with HCV by defining the optimal pre-visit evaluation, and once determined to improve its rate of completion thereby enhancing the referral value and minimizing the duration from diagnosis to establishment of a treatment plan.
We formed a multidisciplinary group of various stakeholders to study this issue. This group included staff physicians, fellows, residents, administrators, schedulers and a patient volunteer. After a thorough investigation including the use of multiple validated quality and process improvement tools to determine root cause and prioritize our potential interventions, we developed three countermeasures, which included the following:
1) Increased appointment slots of vibration-controlled transient elastography (VCTE).
2) The development of a pre-initial visit HCV order set in our electronic medical record (EMR).
3) The implementation of a “pre-call check list” to be utilized by scheduling and nursing.
We assessed our interventions via numerous varied key performance indicators including:
- Amount of optimal work up completed before initial subspecialty visit (e.g. performing 0/8 to 8/8 required tests)
- Time to VCTE
- Utilization of pre-initial visit HCV order set
- Duration of time from diagnosis to HCV directed plan of care
- Pre – Post Patient Satisfaction
- Pre – Post Provider Satisfaction
Overall, we had a significant impact on the number of HCV patients with an optimal completed workup and a defined plan of care.
The creation of a comprehensive management plan through a multidisciplinary approach can both improve the quality of care we provide patients newly diagnosed with HCV, and enhance value by reducing medical waste, redundancy, and inefficient patient encounters. A larger number of HCV patients have a directed care plan, allowing our providers to have an impact on a greater number of patients overall.
Implications for the Patient
It is our hope that by efficiently treating more patients with HCV, we will be able to align globally with population health initiatives, which focus on preventive medicine. We believe that this is the first step to help prevent the development of cirrhosis and sequelae related to chronic HCV.