Hepatitis C Screening Trends in a Large Integrated Health System

Linas, Benjamin P.; Hu, Haihong; Barter, Devra; Horberg, Michael A.

doi:10.1016/j.amjmed.2014.01.012

Cited by 29 publications

(21 citation statements)

References 11 publications

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“…As the 1945–1965 birth cohort has the highest hepatitis C prevalence [ 9 ], the Centers for Disease Control and Prevention and US Preventive Services Task Force recommended they receive 1-time hepatitis C testing regardless of risk factors [ 10 , 11 ]. In previous studies screening has been as low as 1%-16% in eligible patients [ 12 ] and less than half of those positive underwent hepatitis C RNA testing [ 13 – 16 ], the first step in the hepatitis C care cascade. For our large health system in southeast Michigan, we aimed to identify hepatitis C screening rates and linkages to care in patients who test positive for hepatitis C antibody.…”

Section: Introductionmentioning

confidence: 99%

Health Disparities in Hepatitis C Screening and Linkage to Care at an Integrated Health System in Southeast Michigan

2016

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With recommended screening for hepatitis C among the 1945–1965 birth cohort and advent of novel highly effective therapies, little is known about health disparities in the Hepatitis C care cascade. Our objective was to evaluate hepatitis C screening rates and linkage to care, among patients who test positive, at our large integrated health system. We used electronic medical records to retrospectively identify patients, in the birth cohort, who were seen in 21 Internal Medicine clinics from July 2014 to June 2015. Patients previously screened for hepatitis C and those with established disease were excluded. We studied patients’ sociodemographic and medical conditions along with provider-specific factors associated with likelihood of screening. Patients who tested positive for HCV antibody were reviewed to assess appropriate linkage to care and treatment. Of 40,561 patients who met inclusion criteria, 21.3% (8657) were screened, 1.3% (109) tested positive, and 30% (30/100) completed treatment. Multivariate logistic regression showed that African American race, male gender, electronic health engagement, residency teaching clinic visit, and having more than one clinic visit were associated with higher odds of screening. Patients had a significant decrease in the likelihood of screening with sequential interval increase in their Charlson comorbidity index. When evaluating hepatitis C treatment in patients who screened positive, electronic health engagement was associated with higher odds of treatment whereas Medicaid insurance was associated with significantly lower odds. This study shows that hepatitis C screening rates and linkage to care continue to be suboptimal with a significant impact of multiple sociodemographic and insurance factors. Electronic health engagement emerges as a tool in linking patients to the hepatitis C care cascade.

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Section: Introductionmentioning

confidence: 99%

Health Disparities in Hepatitis C Screening and Linkage to Care at an Integrated Health System in Southeast Michigan

2016

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“…Prior to the 2013 USPSTF guidelines, only 14.4% of KPMAS patients within the 1945-1965 birth cohort were screened (15.8% of all adults aged ≥18 years) [21]. Updating these data through 2014 improved screening rates to 17.1% among this birth cohort (18.6% of all adults) [22].…”

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confidence: 99%

Streamlining Screening to Treatment: The Hepatitis C Cascade of Care at Kaiser Permanente Mid-Atlantic States

Jonas

Rodriguez

Redd³

et al. 2016

Clin Infect Dis.

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Hepatitis C virus (HCV) screening is recommended for patients at risk and/or born during , but screening gaps persist. This new program screens target populations and enhances care linkage for chronically HCV-infected patients. Kaiser Permanente Mid-Atlantic States created a comprehensive HCV screening pathway, supported by a HCV care coordinator. The testing pathway includes HCV antibody (Ab), automatic HCV RNA for Ab-positive patients, coinfection and liver health tests, vibration-controlled transient elastography (VCTE), and a physician referral. A total of 11 200 patients were screened; 3.25% were HCV Ab positive, and 100% of Ab-positive patients received HCV RNA testing. Of HCV Ab-positive patients, 75.9% had chronic HCV, of which 80.8% underwent VCTE. HCV diagnosis was communicated to 94% of patients, and 70.9% had HCV documented in the electronic health record. The pathway shows promise in closing gaps, including improving HCV RNA testing, communicating diagnoses, and assessing liver fibrosis. Improved testing and linkage could increase curative treatment access.

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“…Through a series of national directives and interventions, including implementation of electronic health record (EHR) clinical reminders [22], the VA has successfully tested more than half the birth cohort veterans seen in care between 2000-2013, which exceeds testing rates reported in other large health care systems [32]. Incorporation of targeted testing algorithms for at-risk or birth cohort individuals within health system EHRs may potentially enhance HCV testing in other non-VA populations [28, 30].…”

Section: Discussionmentioning

confidence: 99%

Disparities in hepatitis C testing in U.S. veterans born 1945–1965

Sarkar

Esserman

Skanderson

et al. 2016

Journal of Hepatology

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Background/Aims Universal one-time antibody testing for hepatitis C virus (HCV) infection has been recommended by the Centers for Disease Control (CDC) and the United States Preventive Services Task Force (USPSTF) for Americans born 1945-1965 (birth cohort). Limited data exists addressing national HCV testing practices. We studied patterns and predictors of HCV testing across the U.S. within the birth cohort utilizing data from the national corporate data warehouse (CDW) of the U.S. Veterans Administration (VA) health system. Method Testing was defined as any HCV test including antibody, RNA or genotype performed during 2000-2013. Result Of 6,669,388 birth cohort veterans, 4,221,135 (63%) received care within the VA from 2000-2013 with two or more visits. Of this group, 2,139,935 (51%) had HCV testing with 8.1% HCV antibody and 5.4% RNA positive. Significant variation in testing was observed across centers (Range: 7-83%). Older, male, African-Americans, with established risk factors and receiving care from urban centers of excellence were more likely to be tested. Among veterans free of other established risk factors (HIV negative, HBV negative, ALT≤40 U/L, FIB-4≤1.45, or APRI<0.5), HCV antibody and RNA were positive in 2.8% and 0.9%, respectively, comparable to established national average. At least 2.4-4.4% of veterans had scores suggesting advanced fibrosis (APRI≥1.5 or FIB-4>3.25) with >30-43% having positive HCV RNA but >16-20% yet to undergo testing for HCV. Conclusion Significant disparities are observed in HCV testing within the U.S. VA health system. Examination of the predictors of testing and HCV positivity may help inform national screening policies. Lay Summary Analysis of United States Veterans Administration data show significant disparities in Hepatitis C Virus (HCV) testing of veterans born 1945-1965 (birth cohort). A fifth of those not tested had evidence of advanced liver fibrosis. Our data suggests some predictors for this disparity and will potentially help inform future policy measures in the era of universal birth cohort testing for HCV.

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Hepatitis C Screening Trends in a Large Integrated Health System

Cited by 29 publications

References 11 publications

Health Disparities in Hepatitis C Screening and Linkage to Care at an Integrated Health System in Southeast Michigan

Health Disparities in Hepatitis C Screening and Linkage to Care at an Integrated Health System in Southeast Michigan

Streamlining Screening to Treatment: The Hepatitis C Cascade of Care at Kaiser Permanente Mid-Atlantic States

Disparities in hepatitis C testing in U.S. veterans born 1945–1965

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