Sustained and cumulative impact of an electronic medical record‐based alert on a hepatitis C birth cohort screening programme

Abstract

Routine HCV antibody testing of birth cohort patients was endorsed by the CDC and the USPSTF nearly one decade ago. 1,2 Despite these recommendations, screening rates in the United States have remained low, 3 prompting a variety of interventions to increase screening and uptake rates in the target population. 4 We recently reported the short-term results of a system-wide, electronic medical record-based best practice alert (BPA). We found a significant increase in screening rates (SR) in response to the alert. 5 Analysis of the pre-intervention screening activities of individual physicians revealed an underlying power-law distribution, whereby a minority of 'high screeners' generated the majority of test orders. This effect persisted in the months following the intervention; however, pre-and post-intervention screening rates were not significantly correlated. 6

Successful Hepatitis C Birth Cohort Screening and Linkage to Care in a US Community Health System

“…Over the past years, the majority of baby boomer patients have been screened, and continued screening can be expected to result in a further increase in the screening rate. Thus, our study demonstrates the feasibility and potential impact of this approach at the health system level 6,7…”

“…Thus, our study demonstrates the feasibility and potential impact of this approach at the health system level. 6,7 FIGURE 3 Response to Antiviral Therapy a Abbreviations: ITT, intention to treat; SVR, sustained virologic response. a The figure shows the SVR rates in patients whose infection was newly identified through birth cohort screening (blue) and in patients with known infection who were referred for treatment (white).…”

Successes and challenges of best practice alerts to identify and engage individuals living with hepatitis C virus

“…Our BPAs were designed to identify already tested HCV seropositive individuals and appropriately engage them in care at the TOHVHP, irrespective of risk factor(s). In the majority of previously conducted studies in which EMRs were used to identify and link individuals living with HCV to care, BPAs were configured to recommend screening serology to identify people living with HCV based on either the birth cohort or risk-based screening strategies (13)(14)(15)(16)(17)(18)(19)(20). A review of studies found that, by using a riskbased approach for HCV screening, only half of the people living with HCV were ultimately made aware of their status (25).…”