Background: An estimated 3-4 million Americans are living with Hepatitis C virus (HCV) infection and more than half of these individuals are unaware of their HCV status. Baby Boomers (born between 1945 and 1965) are significantly more likely to have HCV infection and should be universally screened. In September 2016, Cook County Health & Hospital System (CCHHS) implemented an electronic clinical decision support (eCDS) tool to increase HCV screening and treatment among Baby Boomers (BB) in primary care sites.
Methods: To assess the impact of the eCDS tool on screening and the successive stages of the HCV care continuum, we analyzed the proportion of patients who completed 1) HCV antibody screening, 2) RNA confirmatory testing, 3) HCV RNA detectable result, 4) liver staging, 5) treatment initiation, and 6) treatment completion.
Results: Between August 2015 and September 2017, the number of BB patients tested for HCV increased by 325% post-implementation of the eCDS tool. During this period, 17,585 BB patients were screened for HCV (3,349 pre-eCDS and 14,236 post-eCDS) and 822 unique patients were HCV antibody reactive (4.7% reactivity). Of 822 HCV antibody reactive patients, 583 (70.9%) completed HCV RNA confirmatory testing (70.0% pre-RNA reflex and 92.0% post-RNA reflex). Of 583 patients with HCV RNA confirmatory testing, 338 (58.0%) had detectable HCV RNA. Of 338 patients with detectable HCV RNA, 190 (56.2%) completed Fibroscan liver staging. Of 190 patients who completed liver staging, 65 (34.2%) patients completed treatment (Illinois Medicaid plans only cover HCV treatment for patients with F-3 and F-4 results). Of 65 patients who initiated treatment, 65 (100%) completed treatment. SVR data was not available for all patients.
Conclusion: The HCV care continuum illustrates the stages at which barriers to accessing HCV medical care attenuate successful treatment of patients. The barriers and (mitigating solutions) are as follows: policy-level (e.g., insurance coverage), institutional-level (e.g., HCV RNA reflex testing), provider-level (e.g., EMR prompts), and patient-level (e.g. provision of support services).
W. Trick, None
H. Zhang, None
L. Diep, None
O. Adeyemi, None