Enhancing the Hepatitis C Cascade of Care: Implementation Science Approach in a Federally Qualified Health Center...

Hepatitis C virus (HCV) remains a significant public health challenge in the United States, particularly among underserved populations. Despite curative treatments, systemic barriers often delay the care cascade.

This quality improvement program aimed at improving the care of patients with chronic Hepatitis C within a Federally Qualified Health Center system in Southern California, known as AltaMed Health Services. The program involves AltaMed, serving more than 700 000 patients, primarily low-income people in underserved communities through an integrated delivery system for Latino and multiethnic individuals, focusing on enhancing screening and treatment processes for Hepatitis C.

A multipronged clinical workflow redesign was evaluated utilizing the RE-AIM framework to assess process and clinical between 2022 and 2024. Intervention included an electronic health record (EHR) Best Practice Advisory to identify patients due for HCV screening, a standardized direct-referral workflow, and a Linkage to Care team to manage prior authorization administrative tasks and patient outreach efforts.

Total descriptive HCV screening volumes increased from 30 212 to 47 951, with screening rates expanding from 3.4% to 7.3% in nonspecialty clinics. Treatment initiation rates shifted from 36% to 45%, and post-treatment patient outreach documentation changed from 48% to 73%. The average duration from diagnosis to treatment initiation was observed to be 55.9% lower, changing from 34 weeks in 2022 and 15 weeks in 2024.

Establishing an Linkage to Care team, combined with automated EHR tools, can track alongside meaningful improvements in the safety-net HCV care cascade. Scaling models require careful consideration of specialized staffing and localized EHR infrastructure to advance health equity and global HCV elimination goals.