Birth Cohort Screening Rates for Hepatitis C in an Internal Medicine Clinic: Before and After an Educational Intervention

Abstract

Introduction: People born during 1945-1965 account for approximately 75% of chronic hepatitis C virus (HCV) infections in the United States. In August 2012, the center for disease control (CDC) advised one-time testing for HCV in adults born from 1945 to 1965 without prior ascertainment of HCV risk. This is a quality improvement project with the aim of raising awareness of birth cohort screening through education of resident and attending physicians. The objective was to increase the screening rate for HCV in an outpatient internal medicine practice. Methods: We determined baseline screening rates by retrospectively measuring the number of HCV antibody assays ordered in a large internal medicine practice for screening purposes only during a 5 month period from January to May 2013. Eligible patients were those new to the practice and born between 1945 and 1965. If they had a prior diagnosis of HCV, they were excluded. We subsequently devoted 1 month to educating the internal medicine housestaff and attendings of the clinic on the updated CDC screening recommendations through lectures and handouts. We then prospectively measured the number of HCV antibody assays ordered during a 5 month period from July to November 2013. The 2 periods were then compared to determine if education had any effect on screening rates. Results: In the pre-intervention period, we examined 139 patient records and 5 were excluded due to a prior history of HCV. In the remaining 134 patients, 3 HCV antibody assays were ordered for a screening rate of 2.2%. In the post-intervention period, 106 patient records were examined and 7 were excluded due to a prior history of HCV. In the remaining 99 patients, 9 HCV antibody assays were ordered for a screening rate of 9.1% which was significantly increased compared to the pre-intervention screening rate (p-value=0.0193). Conclusion: We found a 4-fold increase in screening rates for HCV after our educational intervention. It was notable that the majority of eligible patients were still not screened for HCV. We believe that the education provided to the attending physicians and housestaff contributed to the increase in HCV Ab screening rates.