Hepatitis C virus testing for case identification in persons born during 1945‐1965: Results from three randomized controlled trials

Yartel, Anthony; Rein, David B.; Brown, Kimberly; Krauskopf, Katherine; Massoud, Omar; Jordan, Cynthia L.; Kil, Natalie; Federman, Alex D.; Nerenz, David R.; Brady, Joanne E.; Kruger, Danielle; Smith, Bryce D.

doi:10.1002/hep.29548

Cited by 20 publications

(27 citation statements)

References 40 publications

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“…People who were born between 1945 and 1965, also known as the Baby Boomers, has a disproportionately high incidence of HCV . One‐time screening of the Baby Boomer in primary care setting has been advocated in some countries to improve the diagnosis rate . Unfortunately, this may not be applicable to our locality, where the prevalence rate of HCV infection is too low for this strategy to be cost‐effective.…”

Section: Discussionmentioning

confidence: 99%

Territory‐wide population‐based study of chronic hepatitis C infection and implications for hepatitis elimination in Hong Kong

Hui

Wong

Fung

et al. 2018

Liver International

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Section: Discussionmentioning

confidence: 99%

Territory‐wide population‐based study of chronic hepatitis C infection and implications for hepatitis elimination in Hong Kong

Hui

Wong

Fung

et al. 2018

Liver International

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“…Center 1 (repeated mailings) used the EHR system to identify eligible patients, defined as those born between 1945 and 1965, with at least one primary care visit to a system‐affiliated physician in the past year, and no prior evidence of HCV testing in their medical records. From February 2013 through October 2013, eligible patients were sent letters containing HCV screening information and preregistered laboratory order forms mailed at 0, 4, and 12 weeks, with reminder letters sent at 1 and 8 weeks . A sample of 9000 patients was selected for inclusion (Additional Supporting Information may be found at http://onlinelibrary.wiley.com/doi/10.1002/hep.28880/suppinfo).…”

Section: Methodsmentioning

confidence: 99%

“…Center 1 implemented its intervention using a stratified multi‐clinic individually randomized design. Within each of nine primary care clinics, patients were randomized at a ratio of 1:2 to receive BC testing letters (intervention) or to be tracked as controls . The center delivered a list of eligible patients to the coordinating center that performed the randomization and delivered the list back to the center.…”

Section: Methodsmentioning

confidence: 99%

“…(The assistant did not discuss HCV testing with the patient). If the medical assistant did not respond to the alert, a BPA automatically appeared when the physician opened the patient medical record recommending HCV testing alongside the HCV test order form . Center 2 used a cluster randomized design among 10 primary care practices.…”

Section: Methodsmentioning

confidence: 99%

“…Center 2 used a cluster randomized design among 10 primary care practices. Each of the 10 primary care practices were defined as a cluster and each cluster was randomized in a 1:1 ratio to implement BC testing with a BPA or to provide standard‐of‐care testing . The coordinating center (NORC at the University of Chicago) randomized the primary care practices, and participants were eligible patients visiting the primary care practices.…”

Section: Methodsmentioning

confidence: 99%

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Uptake of hepatitis C screening, characteristics of patients tested, and intervention costs in the BEST‐C study

et al. 2016

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Background From December 2012-March 2014, three randomized trials, each implementing a unique intervention in primary care settings (mail recruitment [repeated-mailing], an electronic health record best practice alert [BPA], and patient-solicitation [patient-solicitation]), evaluated HCV antibody testing, diagnosis, and costs for each of the interventions compared to standard-of-care testing. Multilevel multivariable models were used to estimate the adjusted risk ratio (aRR) for receiving an HCV antibody test, and costs were estimated using activity-based costing. Rationale To estimate the effects of interventions conducted as part of the Birth-cohort Evaluation to Advance Screening and Testing for Hepatitis C study on hepatitis C virus (HCV) testing and costs among persons of the 1945–1965 birth-cohort (BC). Main Results Intervention resulted in substantially higher HCV testing rates compared to standard-of-care (26.9% vs. 1.4% for repeated-mailing, 30.9% vs. 3.6% for BPA, and 63.5% vs. 2.0% for patient-solicitation), and significantly higher aRR for testing after controlling for sex, birth year, race, insurance type, and median household income (19.2 [95% Confidence Interval (CI) 9.7–38.2] for repeated-mailing, 13.2 [95% CI 3.6–48.6] for BPA, and 32.9 [95% CI 19.3–56.1] for patient-solicitation). The BPA intervention had the lowest incremental cost per completed test ($24 with fixed startup costs, $3 without) and also the lowest incremental cost per new case identified after omitting fixed startup costs ($1,691). Conclusion HCV testing interventions resulted in an increase in BC testing compared to standard-of-care but also increased costs. The effect size and incremental costs of BPA intervention (excluding startup costs) support more widespread adoption compared to the other interventions.

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Effect of a Default Order vs an Alert in the Electronic Health Record on Hepatitis C Virus Screening Among Hospitalized Patients

et al. 2022

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IMPORTANCE Hepatitis C virus (HCV) screening has been recommended for patients born between 1945 and 1965, but rates remain low.OBJECTIVE To evaluate whether a default order within the admission order set increases HCV screening compared with a preexisting alert within the electronic health record. DESIGN, SETTING, AND PARTICIPANTSThis stepped-wedge randomized clinical trial was conducted from June 23, 2020, to April 10, 2021, at 2 hospitals within an academic medical center.Hospitalized patients born between 1945 and 1965 with no history of screening were included in the analysis. INTERVENTIONSDuring wedge 1 (a preintervention period), both hospital sites had an electronic alert prompting clinicians to consider HCV screening. During wedge 2, the first intervention wedge, the hospital site randomized to intervention (hospital B) had a default order for HCV screening implemented within the admission order set. During wedge 3, the second intervention wedge, the hospital site randomized to control (hospital A) had the default order set implemented. MAIN OUTCOMES AND MEASURES Percentage of eligible patients who received HCV screeningduring the hospital stay. RESULTSThe study included 7634 patients (4405 in the control group and 3229 in the intervention group). The mean (SD) age was 65.4 (5.8) years; 4246 patients (55.6%) were men; 2142 (28.1%) were Black and 4625 (60.6%) were White; and 2885 (37.8%) had commercial insurance and 3950 (51.7%) had Medicare. The baseline rate of HCV screening in wedge 1 was 585 of 1560 patients (37.5% [95% CI, 35.1%-40.0%]) in hospital A and 309 of 1003 patients (30.8% [95% CI, 27.9%-33.7%]) in hospital B. The main adjusted model showed an increase of 31.8 (95% CI, 29.7-33.8) percentage points in test completion in the intervention group compared with the control group (P <. 001). CONCLUSIONS AND RELEVANCEThis stepped-wedge randomized clinical trial found that embedding HCV screening as a default order in the electronic health record substantially increased ordering and completion of testing in the hospital compared with a conventional interruptive alert. TRIAL REGISTRATION Clinicaltrials.gov: NCT04525690

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Hepatitis C virus testing for case identification in persons born during 1945‐1965: Results from three randomized controlled trials

Abstract: BC testing was effective in identifying previously undiagnosed HCV infections in primary care settings. (Hepatology 2017).

Cited by 20 publications

References 40 publications

Territory‐wide population‐based study of chronic hepatitis C infection and implications for hepatitis elimination in Hong Kong

Territory‐wide population‐based study of chronic hepatitis C infection and implications for hepatitis elimination in Hong Kong

Uptake of hepatitis C screening, characteristics of patients tested, and intervention costs in the BEST‐C study

Effect of a Default Order vs an Alert in the Electronic Health Record on Hepatitis C Virus Screening Among Hospitalized Patients

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