地域医療と健康教育

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Electronic Clinical Decision Support (eCDS) Intervention to Increase Hepatitis C Virus (HCV) Screening and Linkage to Care among Baby Boomers in Urban Safety-Net Health System

Armstrong H, Gonzalez-Drigo M, Adeyemi O, Trick W, Diep L, Zhang H, Catrambone JC, Taussig D and Norels G

Objective: An estimated 3.5 million Americans are living with hepatitis C virus (HCV) infection and the majority is unaware of their infection. HCV causes significant morbidity and mortality and is one of the leading causes of hepatocellular carcinoma (HCC) and other liver complications. Baby boomers (born between 1945 and 1965) account for approximately 75% of people chronically infected with HCV. The CDC and USPSTF recommend universal one-time screening of all Baby Boomers.

Methods: Cook County Health (CCH) implemented an electronic clinical decision support (eCDS) tool in September 2016 to increase HCV screening among baby boomers throughout its outpatient clinic network. We evaluated the impact of the eCDS tool on screening and the successive stages of the care continuum by analyzing the proportion of patients who completed 1) anti-HCV screening, 2) HCV RNA confirmatory testing, 3) HCV RNA detectable result, 4) liver staging, and 5) treatment in the 12-month periods pre- and post-implementation.

Results: The number of baby boomers newly tested system-wide each month increased by 344% over the 24-month evaluation period. Of 15,630 patients tested for anti-HCV, 844 (5.4%) tested positive. Patients with anti-HCV positive results were predominantly male (59%), between the ages of 52 and 64 (70%), Black/African American (71%) and Non-Hispanic (86%). 605 (72%) of anti-HCV positive patients completed HCV ribonucleic acid (RNA) testing; of those patients, 347 (58%) had confirmed HCV infection. Of 347 patients with confirmed HCV infection, 198 completed liver staging and 68 initiated treatment.

Conclusions: Implementation of eCDS tools across large urban safety-net health systems is an effective strategy for ensuring adherence to national guidelines for HCV screening among baby boomers. The high prevalence of HCV infection in this primarily male, Black/African American baby boomer population highlights the urgency of universal screening programs at similar institutions.