Evaluating a New Approach to Inpatient Hepatitis C Virus Screening

Abstract

Introduction: Hepatitis C Virus (HCV) is the most common chronic blood-borne pathogen in the U.S. and is associated with significant morbidity and mortality. In 2013, the Center for Disease Control noted that 75% of HCV-infected patients are born between 1945-1965, prompting new guidelines for screening in this population. Later, New York State implemented a law expanding screening to both outpatient and inpatients. Current literature on inpatient screening is extremely limited, with only one trial evaluating the efficacy and rates of screening. We present a retrospective study evaluating the implementation of a comprehensive HCV screening program in a large urban community hospital. Methods: In August 2015, a new HCV screening initiative was implemented. This included daily interdisciplinary rounds where patients born between 1945-1965 were identified and anti-HCV antibodies were sent. Daily rounds included an associate medical director, hospitalist, social worker, case manager, nurse manager, and Internal Medicine resident. In addition, reflexive RNA testing was introduced. Patients with positive screening tests were then referred to their primary care physician or hepatologist for follow-up. Rates of HCV screening were assessed from October 1, 2014 to December 31, 2014 and October 1, 2015 to December 31, 2015. Results: A total of 522 pre-intervention and 506 post-intervention patients were assessed. Screening rates pre-intervention was low at 4.2%. Post-intervention rates increased to 28.1%, representing a 23.9% increase in screening. 7.7% of patients screened were found to be HCV positive with no prior history of HCV. These patients had a mean age of 63.9 and the majority were either self-pay or on medicaid. Conclusion: HCV is a leading cause of chronic liver disease, cirrhosis, and hepatocellular carcinoma. Early detection and intervention are necessary to prevent end stage liver disease. Research on inpatient screening is extremely limited. We present a study demonstrating the utility of inpatient screening in identifying patients at risk. We also present a novel interdisciplinary approach to HCV screening that is effective in increasing screening rates by nearly 25%. Future research is needed to further elucidate inpatient strategies in increasing HCV screening, detection rates, and linkage to care.Figure 1