Introduction: Screening patients for hepatitis C virus infection is frequently overlooked. This is a leading cause of chronic liver disease in the US. The US Preventive Services Task Force determined screening is beneficial in patients aged 18-79. Previously, only those born between 1945-1965. The American Association for the Study of Liver Diseases recommends a one-time antibody test in adults 18 years and older. Even though treatable, screening rate of hepatitis C virus antibody in patients aged 18-55 or 77-79 is only 70% in the primary care settings in Syracuse, Rome, and Binghamton. Inadequate detection leads to missed treatment opportunities and contributes to significant liver disease. Our quality improvement initiative aims to increase compliance rate with hepatitis C virus screening for all outpatient primary care visits for patients aged 18-55 or 77-79 by 20% from baseline of 70% to 90% in 6 months.
Methods: Data was obtained from internal medicine and family medicine outpatient clinics at three locations (Syracuse, Rome, and Binghamton). Eligible patients were divided into two groups: 18-55 or 77-79 years was the group of interest and 56-76 years (born between years 1945-1965) was the reference group as testing in this group of patients had previously been practiced. Completed testing from July-September 2021 served as baseline. Gap analysis was performed identifying causes of reduced compliance. Interventions were taken at the patient level (distribution of informational flyers and provider education), provider level (education on guidelines), and system level (electronic medical record alerts). Interventions were initiated in October 2021 and testing rates were tracked until the end of February 2022. IRB approval was not pursued.
Results: The rate of screening with hepatitis C virus antibody in patients aged 18-55 or 77-79 improved by 2.3% from 70% to 72.3% from October 1, 2021, to March 31, 2022, across three sites. Binghamton's rate improved by 5%. 397 tests have been ordered during this time and 240 were for the age group of interest.
Discussion: Compliance with hepatitis C viral screening is suboptimal in outpatient settings. Focused and simple interventions at the patient, provider, and system levels can increase compliance and help reduce the burden of significant liver disease. We hypothesize continued education and monitoring of data will demonstrate improved rates due to long time between primary care visits. Additional interventions may improve rates further.
