Improving hepatitis C screening and diagnosis in patients born between 1945 and 1965 in a safety-net primary care clinic

Bakhai, Smita; Nallapeta, Naren S.; El-Atoum, Mohammad; Arya, Tenzin; Reynolds, Jessica L.

doi:10.1136/bmjoq-2018-000577

Cited by 6 publications

(4 citation statements)

References 45 publications

(55 reference statements)

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“…This study consisted of two phases: intervention development (phase 1) and feasibility testing (phase 2). We developed a multilevel intervention prototype aimed at patients and providers to address barriers to HCV screening [ 7 ] based on our work, previous literature, theory-based interventions, and barriers and facilitators to HCV screening specifically [ 9 , 10 ]. This study was reviewed and approved by the authors’ Institutional Review Board.…”

Section: Methodsmentioning

confidence: 99%

Development and Feasibility Testing of a Multilevel Intervention to Increase Hepatitis C Virus Screening Among Baby Boomers in Primary Care

et al. 2023

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Chronic infection with hepatitis C virus (HCV) results in an increased risk of cirrhosis and hepatocellular carcinoma (HCC). Only 15% of baby boomers (born 1945–1965) have ever been screened. We aimed to develop a multilevel intervention to increase HCV screening for baby boomers in a primary care setting. This study included two phases: intervention development (phase 1) and feasibility testing (phase 2). In phase 1, we partnered with a Community Advisory Board and a Provider Advisory Board to develop a multilevel intervention to increase HCV screening to be delivered to both providers and patients in primary care. Phase 2 assessed intervention feasibility, acceptability, and usability by conducting Concurrent Think Aloud (CTA) interviews and surveys using previously validated scales with patients (n = 8) and providers (n = 7). Phase 1 results: The patient-level intervention included a mailed reminder letter and CDC pamphlet and a 7-min in-clinic educational video. The provider-level intervention included a 30-min educational session and monthly performance feedback e-mails. Phase 2 results: Qualitatively, both the patient and provider-level intervention were feasible, acceptable, and usable by the target audiences. Quantitatively, on a 1–4 scale, the range of patient-level scores was 3.00–4.00 and provider level was 3.50–4.00 for feasibility, acceptability, and usability. This intervention could improve HCV screening among a high-risk population and therefore reduce HCV-related morbidity and mortality. This project developed a feasible, acceptable, and usable multilevel intervention aimed at increasing HCV screening in primary care.

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Section: Methodsmentioning

confidence: 99%

Development and Feasibility Testing of a Multilevel Intervention to Increase Hepatitis C Virus Screening Among Baby Boomers in Primary Care

et al. 2023

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“…Our aim statement was achievable and realistic based on 'SMART' goals 9 and based on previous QI projects from this clinic. [10][11][12][13][14][15][16]…”

Section: Problem Descriptionmentioning

confidence: 99%

“…We anticipated many challenges to optimise breast cancer screening rates in this unique patient population; therefore, we selected a 10% improvement within 1 year from the baseline rate. Our aim statement was achievable and realistic based on ‘SMART’ goals9 and based on previous QI projects from this clinic 10–16…”

Section: Introductionmentioning

confidence: 99%

Advancing health equity in improving breast cancer screening with the use of a mobile mammography bus in marginalised population: quality improvement project

Bakhai,

Ansari,

Sadeghi

et al. 2024

BMJ Open Qual

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BackgroundBreast cancer, the second leading cause of cancer-related deaths in women in the USA, is effectively treated through early detection and screening. This quality improvement (QI) project aimed to improve mammography screening rates from the baseline of 50% to 60% within 12 months for patients aged 50–74 years at an Internal Medicine Clinic.MethodsWe used the Plan, Do, Study, Act (PDSA) model. A multidisciplinary team used a fishbone diagram to identify barriers to suboptimal screening. The QI team created a driver diagram and process flow map. The mammogram screening rate was the outcome measure. Mammogram order and completion rates were the process measures. We implemented six PDSA cycles. Major interventions included the use of a nurse navigator, enhancements in health information technology, and education to patients, providers, and nursing staff. Mammograms were offered in a mobile bus, located in the hospital campus and in under-resourced inner-city neighbourhoods to improve the access. Data analysis was performed using monthly statistical process control charts.ResultsThe project exceeded its initial goal, achieving a breast cancer screening rate of 66% (n=490 of 744) during the study period and was sustainable at 69%, 3 months post-project. The mammogram order rate was 58% (n=432 of 744) and completion rate was 53% (n=231 of 432) within 12 months.ConclusionsWe attributed the success of this QI project to the education of patients, nurses and physicians, the use of a nurse navigator and engagement of a multidisciplinary team. Access to mobile mammography bus addressed the social determinants of health barriers in a marginalised population.

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“…Despite Centers for Disease Control and US Preventive Services Task Force recommendations for 1-time HCV screening in all baby boomers (adults born between 1945 and 1965) (12), uptake of HCV screening remains low in some settings. Studies have suggested that less than 20% of baby boomers received screening between 2013 and 2016 (13), and it is estimated that at least half of the 3 million persons infected with HCV in the United States remain undiagnosed, with many being unaware of their HCV status (14,15). Even among those who receive HCV screening, there is discontinuity in downstream processes among those with a positive result, including suboptimal HCV RNA testing and linkage to care.…”

Section: Introductionmentioning

confidence: 99%

Randomized Clinical Trial of Inreach With or Without Mailed Outreach to Promote Hepatitis C Screening in a Difficult-to-Reach Patient Population

et al. 2020

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INTRODUCTION: Hepatitis C virus (HCV) treatment can significantly reduce the risk of liver-related mortality; however, many patients remain unaware of their infection in clinical practice. The aim of this study is to compare the effectiveness of inreach, with and without mailed outreach, to increase HCV screening and follow-up in a large, difficult-to-reach patient population. METHODS: We conducted a pragmatic randomized clinical trial from August 2018 to May 2019 in a large safety-net health system. Patients born between 1945 and 1965 were randomly assigned (1:1) to inreach with an electronic health record reminder to providers (n = 6,195) or inreach plus mailed HCV screening outreach (n = 6,191) to complete HCV antibody screening. Outreach also included processes to promote HCV RNA testing among those with a positive HCV antibody and linkage to care among those with positive HCV RNA. The primary outcome was completion of HCV antibody testing within 3 months of randomization (ClinicalTrials.gov NCT03706742). RESULTS: We included 12,386 eligible patients (median age 60 years; 46.5% Hispanic, 33.0% Black, and 16.0% White). In intent-to-treat analyses, HCV screening completion was significantly higher among inreach-plus-outreach patients than inreach-alone patients at 3 months (14.6% vs 7.4%, P < 0.001) and 6 months (17.4% vs 9.8%, P < 0.001) after randomization. Among those who completed HCV screening within 6 months, a higher proportion of inreach-plus-outreach patients with positive antibody results completed RNA testing within 3 months than inreach-alone patients (81.1% vs 57.1%, respectively, P = 0.02); however, linkage to care within 3 months of HCV infection confirmation did not significantly differ between the 2 groups (48.1% vs 75.0%, respectively, P = 0.24). DISCUSSION: Among difficult-to-reach patients, a combination of inreach and mailed outreach significantly increased HCV screening compared with inreach alone. However, HCV screening completion in both arms remained low, highlighting a need for more intensive interventions.

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Improving hepatitis C screening and diagnosis in patients born between 1945 and 1965 in a safety-net primary care clinic

Cited by 6 publications

References 45 publications

Development and Feasibility Testing of a Multilevel Intervention to Increase Hepatitis C Virus Screening Among Baby Boomers in Primary Care

Development and Feasibility Testing of a Multilevel Intervention to Increase Hepatitis C Virus Screening Among Baby Boomers in Primary Care

Advancing health equity in improving breast cancer screening with the use of a mobile mammography bus in marginalised population: quality improvement project

Randomized Clinical Trial of Inreach With or Without Mailed Outreach to Promote Hepatitis C Screening in a Difficult-to-Reach Patient Population

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