Hepatitis C Screening Among Baby Boomers in an Internal Medicine Residency Practice

Abstract

Introduction: In the United states(US), approximately 3.5 million people are infected with hepatitis C virus (HCV), 80% of whom are “baby boomers” (born between 1945 and 1965). Most of these individuals are asymptomatic thus unaware of their infections. This causes the silent epidemic that burdens the healthcare system due to the high costs of treatment of end stage liver disease and liver cancer. To curb the growing burden of these HCV associated disease, the US preventive services task force(USPTF) recommended one time HCV testing for baby boomers in 2013. Despite the urging of USPTF, the percentage of baby boomers who underwent testing for HCV had barely changed from 12.3 % in 2013 to 13.8% in 2015. Our Internal Medicine residency outpatient practice was also struggling to meet this USPFT recommendation with just 6.5% compliance. Methods: Our clear aim was to improve the HCV screening rate at our outpatient practice by 10% in one year. A root cause analysis was performed and the main reasons for low screening rate included lack of physician awareness about this screening recommendation; barriers to preventive care; unapparent symptoms. On our pre-intervention survey only 44.4%(20/45) of physician reported actively screening of baby boomers for HCV. A Plan-do-study-act (PDSA) was designed to tackles these issues. Multiple interventions were made which included an EMR alert for screening all baby boomers, education of physicians and medical assistants(MA) about needs for HCV screening, empowering the MAs to discuss HCV screening with the patients before the physician visit and providing educational material to patients who refused HCV screening Results: A total of 338 patients were screened for HCV over a period of one year. This increased our compliance rate from 6.5% to 35.4%. Out of the 338-patient screened, 15 (4.4%) tested positive for HCV antibody. 13 out of 15 tested positive for HCV RNA and were referred for treatment. Conclusion: We surpassed our initial goal of !0% increase in compliance with the help of our interventions and PDSA cycles. The new framework has now become a part of workflow and we hope to see further improvement in our compliance rate in the next few months. This methodology can be applied at any outpatient practice with ease.