Attempts to Improve Hepatitis C Screening Rates in a Gastroenterology Fellows\u27 Clinic: A Quality Improvement Initiative

Introduction: The CDC recommends one-time birth cohort HCV testing for individuals born between 1945-1965. Previous quality improvement (QI) projects aiming to improving HCV screening have largely focused on increasing education of screening guidelines. We conducted a QI initiative focusing on improving the rates of HCV birth cohort screening in the Gastroenterology Fellows’ (GI) continuity clinic at an urban tertiary care center. Methods: The baseline rates of HCV birth cohort screening were assessed for patients seen in GI Fellows’ clinic within two months prior to our intervention. The intervention was a standardized documentation statement to be included in all fellows’ electronic medical record clinic notes to allow for clear documentation of the patients’ HCV status. The primary aim of this study was to assess the impact of this intervention on age-appropriate HCV screening achieved within 2 months after the intervention. The secondary aim was to compare baseline HCV screening rates in this urban population of patients. Results: Data was captured for 231 patients in the pre-intervention group and 245 patients in the post-intervention group between July 1, 2017 and December 31, 2017. The median age for both groups was 63 (average year of birth 1955). In the pre-intervention group, 45.1% of patients were male and 23.4% were Caucasian. In the post-intervention group, 42.4% were male and 18.8% were Caucasian. 92 of 231 (39.8%) patients in the pre-intervention group and 80 of 245 (32.7%) patients in the post-intervention group had not received screening for HCV prior to their clinic appointment. 11 of the 92 (12.0%) patients in the pre-intervention group who had lacked prior screening were appropriately screened at their clinic appointment, compared to 12 of 80 (15.0%) in the post-intervention group. There was no significant difference between the groups (p=0.559) (Table). Conclusions: This quality improvement intervention did show unexpectedly high baseline HCV birth cohort screening rates compared to recent published reports. This is likely due to the hospital system’s EMR incorporating electronic alerts for age-based HCV screening. This specific intervention did not show a significant improvement in hepatitis C viral screening rates in the GI fellows’ continuity clinic. The lack of efficacy with this intervention is relevant to allow future alternative approaches for improving screening rates to be explored. Interventions focused on adding documentation for improving screening rates may be onerous for GI clinicians who are seeing patients for primarily non-hepatologic concerns. Our study highlights the need for further quality improvement studies to continue to improve birth cohort HCV screening rates to a goal of 100 percent among GI physicians.https://scholarlycommons.henryford.com/merf2019qi/1006/thumbnail.jp