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Published on: September 26, 2011
Improving HCV Risk Assessment and Testing in a Federally Qualified Health Center Setting in Baltimore, Maryland
Rose A Layman1, Barbara S Turner2, James L Harmon2
1Baltimore Medical System, Baltimore, MD, USA. rose.layman@bmsi.org.
Insights
Implementing targeted interventions significantly improved hepatitis C virus (HCV) risk assessment and testing rates by over 35% and 125% respectively in a Baltimore health center.
Area of Science:
- Public Health
- Infectious Disease Epidemiology
- Healthcare Management
Background:
- Approximately 4.1 million US adults have current or past hepatitis C virus (HCV) infection.
- HCV testing and risk assessment completion rates remain suboptimal, particularly for at-risk populations like the 1945-1965 birth cohort.
- Barriers to HCV screening and testing require targeted interventions within healthcare settings.
Purpose of the Study:
- To reduce barriers to HCV risk assessment and testing.
- To improve HCV risk assessment and testing rates by 30% in a federally qualified health center.
- To enhance HCV detection and follow-up among vulnerable populations.
Main Methods:
- Integrated staff education, streamlined risk assessment, EHR alerts, push reports, and standing orders into primary care workflow.
- Evaluated risk assessment tool use and testing rates one month before and after intervention implementation.
- Analyzed data from 8911 patients pre-intervention and 8228 patients post-intervention.
Main Results:
- HCV risk assessments increased by 35% (2973 to 3708).
- HCV testing rates improved by 125% (1831 to 3790).
- Seropositivity prevalence rose from 2.1% to 2.9% post-intervention.
Conclusions:
- Workflow efficiencies and staff education successfully boosted HCV screening and testing completion rates.
- Integrated strategies in primary care workflows can effectively increase HCV detection.
- Timely follow-up for vulnerable populations is enhanced through improved screening practices.
Abstract:
Approximately 4.1 million adults in the United States have past or current hepatitis C virus (HCV) infection. Despite efforts to test at least once for the 1945-1965 birth cohort population and others identified at risk, the completion of the annual risk assessment tool and testing of these patients has been suboptimal. The aim of this project was to reduce HCV risk assessment and testing barriers and improve both these rates by 30% within a federally qualified health center setting in Baltimore, Maryland. As part of ongoing efforts to promote HCV risk screening and testing, targeted interventions of staff education, streamlined risk screening assessment, automated electronic health record alerts, push reports, and standing orders were integrated into current screening and testing practices. This study examined the risk assessment tool use and testing rates for 1 month before and after project implementation. All patients who were seen for a primary care visit during the month preceding (n = 8911) and following (n = 8228) the intervention were evaluated. A total of 2973 risk assessments and 1831 HCV tests were completed pre-intervention compared to 3708 risk assessments and 3790 tests post-intervention, demonstrating a 35% and 125% improvement respectively. Seropositivity prevalence of 2.1% pre-intervention increased to 2.9% post-intervention. Efficiencies in workflow processes and staff education successfully impacted the HCV risk screening tool completions and testing rates for the birth cohort and non-birth cohort patients. Integrating such strategies in the primary care workflow can increase HCV detection and timely follow up for vulnerable populations.
