- 50% of the 3.5 million Americans with Hepatitis C have been diagnosed.
- Hepatitis C is the leading cause of liver transplantation and liver cancer
- People born between 1945-1965 account for 73% of all Hepatitis C liver-related mortality.
- Between 2013-2015, only 11.5-12.8% of these people were screened.
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- At Farrell Community Health Center, between October 2016 – September 2017, 29% of patient were tested for Hepatitis C, and 3% of those tested were positive.
Hepatitis C Screening Rates at Farrell Family Medicine Community Health Center:
A Resident-Driven Quality Improvement Project
Danielle LaSalandra, DO; Sheerin Habibullah, MD; Mary Warren, MD; Elizabeth Han, DO; Rebecca Roach, MD; Hyowoun Jyung, MD
Heather Paladine, MD; Urmi Desai, MD; Susan Lin, PhD
Stakeholder Interviews:
- Front Desk Staff: Aware of patient’s date of birth. Giving a form might be too much work but placing a sticker on the chart might be possible.
- Medical Assistants: Unsure if Hepatitis C screening is an issue and who should be screened. Rarely see Hepatitis C lab order.
- Residents: Some think about Hepatitis C testing often; others less frequently. Pop ups, visual reminders, preceptor reminders would be helpful.
- Faculty: Often think about screening. Mostly do not remind residents during precepting.
- EMR queried each month
- Percentage of patients born between 1945-1965 in the past month who received hepatitis C screening
- Did not differentiate between providers
Posters (Intervention 2 and 5):
- Most effective ways to make changes may be initiating active discussion among providers regardless of interventions.
- Efficacy of interventions that rely on patients, such as posters, likely dependent on health literacy level and engagement of patient population.
- Efficacy of interventions that rely on providers, such as an acronym expander, is highly dependent on engagement and utility by the providers.
- Sustained effect of the intervention months after, may be secondary to increased acronym expansion usage, awareness, and culture change.
- Increase in screening percentages over the past year may also be secondary to growing national awareness of Hepatitis C.
- Involve more staff members: can enlist administrative assistants, medical assistants, and nurses to flag patients born between the target years.
- Target patients through direct outreach.
- Consistent reinforcement for faculty members to remind residents about Hepatitis C screening while precepting.
- Physician specific data driven intervention: provide individual percentage screening rate.
- Rising Mortality Associated With Hepatitis C Virus in the United States, 2003–2013. Clinical Infectious Disease
- Monica L. Kasting, Anna R. Giuliano, Richard R. Reich, Richard G. Roetzheim, David R.Nelson, Elizabeth Shenkman and Susan T. Vadaparampil Hepatitis C Virus Screening Trends: Serial Cross-Sectional Analysis of the National Health Interview Survey Population, 2013–2015. Cancer Epidemiol Biomarkers Prev March 27 2018 DOI: 10.1158/1055-9965.EPI-17-0855
- Linas et al. Hepatitis C screening trends in a large integrated health system.Am J Med. 2014 May;127(5):398-405. doi: 10.1016/j.amjmed.2014.01.012. Epub 201
Increase the Hepatitis C screening rate for patients who were born from 1945-1965 from a baseline of 29% to 40% over 6 months at Farrell Community Health center.
Acronym Expansion (Intervention 3 and 4):
- Did not initially meet Smart Aim to increase screening rate to 40% over six months; however did reach goal longitudinally.
- Most effective intervention: initial announcement of project
- Other effective interventions: acronym expander, poster in preceptor room
*Baseline data obtained from percent of patients screened between 10/2016 – 9/2017
Screening Rates for Hepatitis C Virus Among Eligible Patients – One Year After Quality Improvement Interventions
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