463. Identifying Risk factors for Non-Birth Cohort Hepatitis C Testing in a Large Healthcare System
Session: Poster Abstract Session: Hepatitis C
Thursday, October 27, 2016
Room: Poster Hall
  • ID Week 2016- N-BC Risk Factors Poster Final.pdf (1.1 MB)
  • Background: Eliminating hepatitis C (HepC) from the United States is feasible, as reported by the National Academy of Medicine in April 2016, though multiple barriers exist. Implementing electronic health record (EHR)-based screening and testing protocols for non-Birth Cohort (n-BC) patients can be complicated as risk factors (RF) are often unstructured and not searchable using commonly available technologies. This study examines RFs associated with n-BC testing within a large healthcare system.

    Methods: In January 2015, A MedStar-Wide HepC Linkage to Care Navigation program was established with Gilead FOCUS funding. A MedStar-wide, primary care EHR-based BC HepC testing protocol went live in July of 2015. N-BC HepC test results were collected as a marker for patients at high risk for HepC, though not prompted. A convenience sample of 100 charts was selected, retrospectively reviewed and a descriptive analysis was conducted, to identify RFs associated with n-BC HepC testing.

    Results: Between July 2015 and March 2016, 3,294 n-BC HepC tests were conducted across the MedStar Health primary care network. Mean age of total was 37 +- 13.9, mean age of sample was 39 +- 13.5 (p<0.01). There were no statistically significant differences between the total and convenience sample regarding sex and race/ethnicity. In the 100-person sample, 18 were HepC Ab positive (HepC+). A total of 45 patients had RFs that included: 11 with elevated LFTs, 5 country of origin or blood transfusion, 5 exposure to other STIs, 4 high risk sexual behavior, 4 spousal infidelity, 4 intravenous drug usage (IVDU)/snorting, 1 HIV diagnosis; 11 had two or more RFs. Of the 12 (27%) HepC+ within the 45, 9 (75%) were black and 9 (75%) were male. Additionally, 55 patients were tested without a discernable RF: 6 (11%) tested HepC+, of which 4 (67%) were black, and 4 (67%) were women.

    Conclusion: Not testing patients born outside of the BC may result in exclusion of an at-risk HepC population. In this sample, 11% of those without risk factors were HepC+ (33% of all HepC+ patients) and would not have been identified if the provider had only followed CDC RF recommendations. Because patients are not always forthcoming with RFs, this may provide evidence for universal HepC testing. Further evaluation is warranted.

    Whitney Nichols, MS, Medstar Health Research Institute, Washington, DC, Alexander Geboy, MS, MedStar Health Research Institute at MedStar Washington Hospital Center, Washington, DC, Idene Perez, CMA, Medstar Health Research Institution, Washington, DC, Stephen Fernandez, MPH, Medstar Health Research Institution, Hyattsville, MD, Peter Basch, M.D, MACP, IT Quality and Safety, Research, National Health IT Policy, Medstar Health, Columbia, MD and Dawn Fishbein, MD, MS, Infectious Diseases, MedStar Washington Hospital Center, Washington DC, DC


    W. Nichols, Gilead: Grant Investigator , Research support

    A. Geboy, Gilead: Grant Investigator , Research support

    I. Perez, Gilead: Grant Investigator , Research support

    S. Fernandez, Gilead: Grant Investigator , Research support

    P. Basch, None

    D. Fishbein, Gilead: Grant Investigator , Scientific Advisor and Shareholder , Research grant , Research support and Speaker honorarium

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