317. Utility of a Hepatitis C Screening Best Practice Advisory in University-based Primary Care Practices

Abstract

BackgroundHepatitis C virus infection (HCV) is a significant health concern in the United States, impacting an estimated 3 million people. Adults born between 1945 and 1965 (“baby boomers”) are 5 times more likely to have HCV infection compared with the general population. In 2012, the CDC recommended screening of adults born between 1945 and 1965. In April 2018 UConn Health transitioned from utilizing the Next Gen EHR system to Epic. At Epic launch, an HCV-screening Best Practice Advisory (BPA) was implemented, along with 13 other outpatient-based BPAs. This allowed for comparison of HCV screening rates before and after Epic launch.MethodsData were collected via retrospective chart review on adults born between 1945–1965 presenting to UConn primary care (PC) clinics one year prior to and 9 months post Epic launch. The BPA was set to fire for patients in the birth cohort who did not have an HCV antibody result or a history of hepatitis C in the medical record. Proportions were compared using chi-squared tests and Fisher’s Exact test.ResultsThe HCV screening rate among PC providers 1-year pre-BPA was approximately 7.7%. Analysis of data nine months after BPA implementation demonstrated HCV screening rates were unchanged at 7.6%. Table 1 describes initial care cascade findings. During the post-launch monitoring period, a 0.2% [270/105,431] response rate was noted (as measured by follow-up actions taken from all BPAs, Table 2). During the same period, a significantly higher response rate to the HCV-screening BPA was noted (1.2% [287/24,532], P < 0.01) (Figure 1).ConclusionThe aim of this study was to improve HCV case identification and to understand the utility of a BPA in this setting. Within the first nine months, the use of an HCV-screening BPA (Figure 2) in PC clinics did not increase screening rates in adults born between 1945 -1965. Alert fatigue may contribute to low screening rates post BPA, as evidenced by the low response rates across all BPAs introduced. Our long-term goal is to gather additional data to assess the efficacy of the HCV BPA and its effects on the HCV care cascade. Modifications to BPA functionality may be indicated. Disclosures All authors: No reported disclosures.