The performance of process measures in hepatitis C.

Area of Science:

• Hepatology and Viral Hepatitis Research
• Clinical Quality Improvement and Health Services Research
• Medical Informatics and Data Validation

Background:

• Evaluating standard chronic hepatitis C virus (HCV) care processes in routine clinical settings is challenging.
• Previous assessments often rely on automated data, whose accuracy in capturing care exceptions is uncertain.

Purpose of the Study:

• To assess adherence to 24 HCV-specific process measures using automated data and medical chart reviews.
• To evaluate the agreement between automated registry data and detailed medical chart records for HCV care.
• To determine the impact of justifiable patient exceptions on measured HCV care quality.

Main Methods:

• Analysis of 122,744 patients in the Veterans Administration HCV Clinical Case Registry (2000-2006).
• Medical chart review of 717 patients to validate registry data and identify care exceptions.
• Calculation of performance rates with and without accounting for exceptions like patient refusal or contraindications.

Main Results:

• Significant variation in adherence to individual HCV care measures (e.g., genotype testing 74%, antiviral treatment 23%).
• Excellent agreement (>0.75) found between automated registry data and medical charts.
• Accounting for exceptions substantially increased performance rates (e.g., genotype testing from 75% to 93%; antiviral treatment from 26% to 64%).

Conclusions:

• Automated data alone underestimates HCV process of care by missing exceptions documented in clinical notes.
• Future quality assessment initiatives relying solely on automated data may require adjustments for documented exceptions.
• Hepatitis A vaccination and antiviral treatment rates in the Veterans Administration require further improvement.