Coinfection with hepatitis A virus (HAV) or hepatitis B virus (HBV) in patients with chronic hepatitis C virus (HCV) is associated with increased morbidity and mortality. The Center for Medicare and Medicaid Services has identified HAV and HBV vaccination as a priority area for quality measurement in HCV. It is unclear to what extent patients with HCV meet these recommendations. We used national data from the Department of Veterans Affairs HCV Clinical Case Registry to evaluate the prevalence and predictors of meeting the quality measure (QM) of receiving vaccination or documented immunity to HAV and HBV in patients with chronic HCV. We identified 88,456 patients who had overall vaccination rates of 21.9% and 20.7% for HBV and HAV, respectively. The QM rates were 57.0% and 45.5% for HBV and HAV, respectively. Patients who were nonwhite or who had elevated alanine aminotransferase levels, cirrhosis, or human immunodeficiency virus were more likely to meet the HBV QM. Factors related to HCV care were also determinants of meeting the HBV QM. These factors included receiving a specialist consult, genotype testing, or HCV treatment. Patients who were older, had psychosis, and had a higher comorbidity score were less likely to meet the HBV QM. With a few exceptions, similar variables were related to meeting the HAV QM. The incidence of superinfection with acute HBV and HAV was low, but it was significantly lower in patients who received vaccination than in those who did not. Conclusion: Quality measure rates for HAV and HBV are suboptimal for patients with chronic HCV. In addition, several patient-related factors and receiving HCV-related care are associated with a higher likelihood of meeting QMs. (HEPATOLOGY 2011;53:42-52) H epatitis C virus (HCV) is the most common blood-borne chronic infection in the United States, with 4.1 million (1.6%) individuals infected, of whom 3.2 million (1.3%) have chronic HCV.1 Veterans have been disproportionately affected by HCV, with reported prevalence rates ranging from 5% to 35%, 2-5 resulting in a substantial increase in the burden of liver disease in the Department of Veterans Affairs (VA) health care system.
6Multiple guidelines and consensus panels recommend vaccination for hepatitis A virus (HAV) and hepatitis B virus (HBV) in patients with chronic HCV infection. [7][8][9][10][11] The Center for Medicare and Medicaid Services has identified HAV and HBV vaccination rates as one of the priority areas for quality measurement in the management of individuals with HCV infection. HAV and HBV vaccination rates in individuals with HCV are now part of Medicare's Physician Quality Reporting Initiative-a voluntary program that ties a reimbursement incentive to compliance with performance on a range of quality measures (QMs).12 Medicare defines vaccination