scholarly journals Improving adherence to hepatitis C screening guidelines

2018 ◽  
Vol 7 (2) ◽  
pp. e000108 ◽  
Author(s):  
Jane Trinh ◽  
Nicholas Turner
Keyword(s):  
Hepatitis C ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Primary Care Clinic ◽  
Improvement Project ◽  
Care Clinic ◽  
Screening Guidelines ◽  
Post Hoc Analysis ◽  
Hcv Screening ◽  
Post Hoc

BackgroundHepatitis C (HCV) is a viral liver disease that can result in cirrhosis, hepatocellular carcinoma, liver transplantation or death. The Centers for Disease Control (CDC) estimates that 2.7–3.9 million Americans are living with HCV, yet the majority are unaware. Starting in 2013, both CDC and US Preventative Services Task Force guidelines agreed in recommending HCV screening for all those born between 1945 and 1965 yet many clinics have been slow to adopt screening.ObjectiveWe designed a quality improvement project seeking to improve HCV screening rates among patients seen for new or annual visits to ≥90% over a 3-year period in an academic primary care clinic.MethodsScreening rates were assessed through repeated review of charts (50 per cycle or 300 charts total, roughly 35% of eligible visits) as a series of interventions were executed. Sustainability was assessed by repeating an additional 50-chart analysis 1 year after completion of the study interventions. At the conclusion of the study, a post hoc analysis of socioeconomic factors was undertaken to determine whether gender, income or ethnicity might affect screening rates.ResultsOver 6 cycles of interventions, screening rates improved from 24% to ≥90%. Screening rates remained at 88% 1 year after completion of the interventions. The most effective interventions used reminders built into our electronic medical record and informed providers of their personal HCV screening rates relative to the clinic as a whole. Our post hoc analysis found that lower socioeconomic standing and white race were associated with reduced likelihood of screening.ConclusionsProvider adoption of new HCV screening guidelines can be markedly and sustainably increased with electronic medical record prompts as well as directed feedback informing providers of their personal screening rates compared with colleagues.

scholarly journals Using the electronic medical record to increase testing for HIV and hepatitis C virus in an Appalachian emergency department

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Carmen N. Burrell ◽  
Melinda J. Sharon ◽  
Stephen Davis ◽  
Judith Feinberg ◽  
Elena M. Wojcik ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Best Practice ◽  
Linkage To Care ◽  
Patient Navigators ◽  
Hcv Screening ◽  
Hcv Testing

Abstract Background The ongoing Appalachian opioid epidemic has led to increasing hepatitis C virus (HCV) infections among people who inject drugs (PWID), and Human Immunodeficiency Virus (HIV) outbreaks have been observed. The primary aim of this study was to assess the potential increase in screening for HIV and HCV in an academic central Appalachian emergency department (ED) through the use of Best Practice Alerts (BPAs) in the electronic medical record (EMR). A secondary aim was to assess for an increase in linkage to care using patient navigators. Methods EMR algorithms based on current Centers for Disease Control and Prevention HIV and HCV testing recommendations were created that triggered Best Practice Alerts (BPAs), giving providers a one-click acceptance option to order HIV and/or HCV testing. Placards were placed in care areas, informing patients of the availability of routine screening. Patient navigators facilitated linkage to care for seropositive patients. Results The BPA appeared 58,936 times on 21,098 patients eligible for HIV screening and 24,319 times on 11,989 patients eligible for HCV screening over a one-year period. Of those, 7106 (33.7%) patients were screened for HIV and 3496 (29.2%) patients were screened for HCV, for an overall testing increase of 2269% and 1065% for HIV and HCV, respectively. Linkage to care increased by 15% for HIV to 100, and 14% for HCV to 64%. Conclusion HIV and HCV screening and linkage to care were increased in an academic ED setting in central Appalachia using EMR alerts. This approach could be utilized in multiple ambulatory settings. Increased testing and earlier linkage to care may help combat the current injection drug use-related HCV epidemic and avoid additional HIV outbreaks.

scholarly journals Using the Electronic Medical Record to Increase Testing for HIV and Hepatitis C Virus in An Appalachian Emergency Department

2020 ◽  
Author(s):  
Carmen Burrell ◽  
Melinda J. Sharon ◽  
Stephen Davis ◽  
Judith Feinburg ◽  
Elena M. Wojcik ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Linkage To Care ◽  
Primary Objective ◽  
Patient Navigators ◽  
Hcv Screening ◽  
Hcv Testing

Abstract Background: The ongoing Appalachian opioid epidemic has led to increasing hepatitis C virus (HCV) infections among people who inject drugs (PWID), and Human Immunodeficiency Virus (HIV) outbreaks have been observed. The primary objective of this study was to use the electronic medical record (EMR) to increase HIV and HCV testing in a central Appalachian academic emergency department. A secondary objective was to increase linkage to care using patient navigators. Methods: EMR algorithms based on current Centers for Disease Control and Prevention HIV and HCV testing recommendations were created that triggered Best Practice Alerts (BPAs), giving providers a one-click acceptance option to order HIV and/or HCV testing. Placards were placed in care areas, informing patients of the availability of routine screening. Patient navigators facilitated linkage to care for seropositive patients. Results: The BPA appeared 58,936 times on 21,098 patients eligible for HIV screening and 24,319 times on 11,989 patients eligible for HCV screening over a one-year period. Of those, 7,106 (33.7%) patients were screened for HIV and 3,496 (29.2%) patients were screened for HCV, for an overall testing increase of 2,269% and 1,065% for HIV and HCV, respectively. Linkage to care increased by 15% for HIV to 100%, and 14% for HCV to 64%. Conclusion: HIV and HCV screening and linkage to care were increased in an academic ED setting in central Appalachia using EMR alerts. This approach could be utilized in multiple ambulatory settings. Increased testing and earlier linkage to care may help combat the current injection drug use-related HCV epidemic and avoid additional HIV outbreaks

Post-intervention lung cancer screening compliance among internal medicine resident physicians at a primary care clinic in Hartford, Connecticut.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6569-6569
Author(s):  
Nerea Lopetegui-Lia ◽  
Daniel Condit ◽  
Gian Carlo Castor Lima ◽  
Dimitrios Drekolias ◽  
Jasmin Hundal ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Lung Cancer ◽  
Primary Care Clinic ◽  
Screening Tests ◽  
Smoking History ◽  
Post Intervention ◽  
Screening Criteria ◽  
Care Clinic ◽  
Screening Guidelines ◽  
Insurance Approval

6569 Background: Lung cancer (ca) screening has shown to reduce mortality by up to 20%.Despite this, only 4% of eligible patients in the US undergo screening. Our initial analysis revealed that 18.3% of patients who met screening criteria had an appropriately ordered LDCT scan, with an 8.7% completion rate. The aim of this study was to improve lung ca screening compliance following the USPSTF guidelines among residents from the University of Connecticut Internal Medicine (IM) residency program at a Clinic in Hartford, Connecticut. Methods: Care provided to patients by an IM resident at the Gengras Clinic were included. After initial data was gathered, we implemented an intervention to improve screening compliance between October 2019 and March 2020, when SARS-CoV-2 pandemic occurred and routine services were interrupted. USPSTF screening guidelines were emailed monthly to residents and attendings; they were reminded of the importance of lung ca screening; updating the pack-year smoking history; as well as instructions on correctly ordering LDCT and documenting shared decision making, which is needed for insurance approval. In-person reminders also occurred at the clinic. Results: Post-intervention, 601 charts were reviewed. 168/601 (27%) patients met screening criteria. 433 patients were excluded due to unclear pack-year, did not meet screening criteria, were deceased or last seen at the clinic prior to the intervention. 63/168 (37.5%) met the criteria and had an appropriately ordered LDCT; 51/168 (30.35%) had a completed LDCT in chart. The remaining 12/168 (7.14%) with an appropriately ordered LDCT, had it scheduled at the time of data collection or it had been cancelled for unclear reasons. 20 patients’ LDCT was ordered by their pulmonologist. 94 (62.5%) who met screening criteria did not have a LDCT ordered. 11 patients with a smoking history, who did not meet screening criteria had a LDCT ordered because of clinical suspicion for cancer. Lastly, 4/168 (2.4%) had a diagnosis of personal history of lung ca. Conclusions: After our educational intervention, patients who qualified had an increase of LDCT being ordered (37.5% from 18.3%) and completed (30.3% from 8.7%). This is, to our knowledge, the first study of its kind. We identified areas of improvement that were key to achieving higher screening rates: educating all residents and attendings on lung ca screening guidelines; educating patients on the importance of undergoing screening tests; creating a best practice advisory in the electronic medical record system that reminds provider to input pack-year smoking history and if the criteria for screening is met, a pop-up prompting the provider to order LDCT; obtaining insurance approval; and lastly, stressing the importance on screening and overall outcomes.

scholarly journals Electronic medical record‐verified hepatitis C virus screening in a large health system

2019 ◽  
Vol 8 (10) ◽  
pp. 4555-4564 ◽  
Author(s):  
Monica L. Kasting ◽  
Anna R. Giuliano ◽  
Richard R. Reich ◽  
Linh M. Duong ◽  
Julie Rathwell ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Health System ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Virus Screening
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