HCV universal EHR prompt successfully increases screening, highlights potential disparities

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Health Informatics

Background:

• Hepatitis C virus (HCV) screening is vital for preventing cirrhosis and liver cancer.
• Universal screening is a key strategy for the global elimination of HCV, a curable disease.

Purpose of the Study:

• To evaluate changes in HCV screening rates and patient demographics after implementing an electronic health record (EHR) alert for universal screening.
• To assess the impact of the EHR alert on screening in an outpatient setting within a large US healthcare system.

Main Methods:

• Data from 2017-2021 on outpatient demographics and HCV antibody screening dates were extracted from EHRs.
• Multivariable regression analyses compared screened and unscreened populations pre- and post-EHR alert implementation.
• Models examined socio-demographic factors, time period, sex interaction, and potential COVID-19 impact on screening.

Main Results:

• The number of HCV screens increased by 103%, and the screening rate rose by 62% after the EHR alert.
• Patients with Medicaid were more likely to be screened (ORadj 1.10) than those with private insurance.
• Black patients were more likely to be screened (ORadj 1.59) than White patients, while Medicare patients were less likely (ORadj 0.62).

Conclusions:

• Universal EHR alerts are a critical tool for advancing HCV elimination efforts.
• Screening rates for Medicare and Medicaid populations did not align with national HCV prevalence, indicating persistent disparities.
• Findings support enhanced screening and re-testing initiatives for individuals at high risk of HCV.