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An Electronic Health Record-based Intervention to Promote Hepatitis C Virus Testing Among Adults Born Between 1945
Alex D Federman1, Natalie Kil, Joseph Kannry
1*Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai †Mount Sinai Health System, New York, NY ‡Centers for Disease Control and Prevention, Atlanta, GA §NORC at the University of Chicago, Chicago, IL ∥Department of Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, New York, NY ¶Valley Medical Group, Greenfield, MA.
Background:
The Centers for Disease Control and Prevention (CDC) recommends one-time hepatitis C virus (HCV) antibody testing for "Birth Cohort" adults born during 1945-1965.
Objective:
To examine the impact of an electronic health record (EHR)-embedded best practice alert (BPA) for HCV testing among Birth Cohort adults.
Design:
Cluster-randomized trial was conducted from April 29, 2013 to March 29, 2014.
Subjects And Setting:
Ten community and hospital-based primary care practices. Participants were attending physicians and medical residents during 25,620 study-eligible visits.
Intervention:
Physicians in all practices received a brief introduction to the CDC testing recommendations. At visits for eligible patients at intervention sites, physicians received a BPA through the EHR to order HCV testing or medical assistants were prompted to post a testing order for the physician. Physicians in control sites did not receive the BPA.
Main Outcomes:
HCV testing; the incidence of HCV antibody positive tests was a secondary outcome.
Results:
Testing rates were greater among Birth Cohort patients in intervention sites (20.2% vs. 1.8%, P<0.0001) and the odds of testing were greater in intervention sites after controlling for imbalances of patient and visit characteristics between comparison groups [odds ratio (OR), 9.0; 95% confidence interval, 7.6-10.7). The adjusted OR of identifying HCV antibody positive patients was also greater in intervention sites (OR, 2.1; 95% confidence interval, 1.3-11.2).
Conclusions:
An EHR-embedded BPA markedly increased HCV testing among Birth Cohort patients, but the majority of eligible patients did not receive testing indicating a need for more effective methods to promote uptake.
