Birth Cohort-Based HCV Testing Infrequently Performed in the United States

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After the system-wide implementation of the best practice alert, testing rates increased from 0.68% to 10.76%.
After the system-wide implementation of the best practice alert, testing rates increased from 0.68% to 10.76%.

The rate of hepatitis C virus antibody (HCV-Ab) testing is low among baby boomers, although the use of an electronic medical record-driven best practice alert (BPA) can significantly improve screening rates, according to results published in the Journal of Translational Internal Medicine.

The results indicated that patients who were screened for HCV-Ab tended to already have known risk factors or established liver disease. They also suggested that guidelines-based, birth cohort-based HCV testing is suboptimal.

The study included participants in a group of insured birth cohort patients between 2010 and 2015. The researchers assessed HCV-Ab test results, clinical variables, and demographic variables from the electronic medical record and used logistic regression to analyze factors associated with testing.

An automated BPA was then used to identify unscreened participants at point of care and to prompt HCV testing. The researchers compared screening rates before and after the systemwide implementation of the BPA.

The results showed a historic HCV-Ab testing rate of 11.2% (11,976/106,753). During the 1-month sampling period, true age cohort-based testing was performed in only 0.68% of participants (69/10,089).

After the system-wide implementation of the BPA, testing rates increased from 0.68% to 10.76% (P <.0001).

The researchers found that younger age, female sex, African-American/Asian/Hispanic ethnicity, and medical comorbidities such as chronic hemodialysis, HIV infection, rheumatologic comorbidities, and psychiatric comorbidities were associated with higher testing rates.

"Our study highlights the suboptimal implementation of current HCV birth-cohort screening guidelines, and provides a rationale for quality improvement initiatives to address this important public health challenge," the researchers wrote.

The research reported in this manuscript was funded through an educational grant from Gilead Sciences Inc.

Reference

Yeboah-Korang A, Beig MI, Khan MQ, et al. Hepatitis C screening in commercially insured U.S. birth-cohort patients: factors associated with testing and effect of an EMR-based screening alert. J Transl Intern Med. 2018;6(2):82-89.

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