Abstract
BackgroundWhile few countries and healthcare systems are on track to meet the World Health Organization’s hepatitis C virus (HCV) elimination goals, the US Veterans Health Administration (VHA) has been a leader in these efforts. We aimed to determine which implementation strategies were associated with successful national viral elimination implementation within the VHA.MethodsWe conducted a five-year, longitudinal cohort study of the VHA Hepatic Innovation Team (HIT) Collaborative between October 2015 and September 2019. Participants from 130 VHA medical centers treating HCV were sent annual electronic surveys about their use of 73 implementation strategies, organized into nine clusters as described by the Expert Recommendations for Implementing Change taxonomy. Descriptive and nonparametric analyses assessed strategy use over time, strategy attribution to the HIT, and strategy associations with site HCV treatment volume and rate of adoption, following the Theory of Diffusion of Innovations.ResultsBetween 58 and 109 medical centers provided responses in each year, including 127 (98%) responding at least once, and 54 (42%) responding in all four implementation years. A median of 13–27 strategies were endorsed per year, and 8–36 individual strategies were significantly associated with treatment volume per year. Data warehousing, tailoring, and patient-facing strategies were most commonly endorsed. One strategy—“identify early adopters to learn from their experiences”—was significantly associated with HCV treatment volume in each year. Peak implementation year was associated with revising professional roles, providing local technical assistance, using data warehousing (i.e., dashboard population management), and identifying and preparing champions. Many of the strategies were driven by a national learning collaborative, which was instrumental in successful HCV elimination.ConclusionsVHA’s tremendous success in rapidly treating nearly all Veterans with HCV can provide a roadmap for other HCV elimination initiatives.
Highlights
While few countries and healthcare systems are on track to meet the World Health Organization’s hepatitis C virus (HCV) elimination goals, the United States (US) Veterans Health Administration (VHA) has been a leader in these efforts
Anticipating the coming direct-acting antiviral medications (DAAs), in late 2014, the Veterans Health Administration (VHA) formed the Hepatic Innovation Team (HIT) Collaborative, which consisted of regional, interdisciplinary teams of providers and other stakeholders [7] to support implementation of the new HCV treatment
HCV viral elimination efforts have been a tremendous population health success in VHA. In this longitudinal assessment of implementation strategies, we identified how strategy use, dose, and effectiveness changed over the course of a highly successful national effort, both over time and between sites that were earlier vs. later adopters of direct acting antiviral treatments
Summary
While few countries and healthcare systems are on track to meet the World Health Organization’s hepatitis C virus (HCV) elimination goals, the US Veterans Health Administration (VHA) has been a leader in these efforts. Most countries, including the US, are not on track to meet WHO targets This is because implementation of new treatments, even of highly efficacious, curative medications, can be challenging due to barriers at the patient, provider, organizational, and systems levels [5]. The VHA far exceeded other healthcare systems [2, 3, 12] by treating nearly 85% of Veterans with known chronic hepatitis C in VHA care [7, 13, 14] This program evaluation aimed to understand which implementation strategies were influential in achieving that outcome
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