Default Orders in the Electronic Health Record Increase Hepatitis C Screening Rates

hep c
Hepatitis C virus (close to the Flavivirid family). HCV causes blood-borne hepatitis, cirrhosis occurs in 25% of cases, 10 to 20 years after the onset of infection, with a risk of hepatic carcinoma. Image made from transmission electron microscopy. Approximate viral diameter: 50 to 60 nm. (Photo by: BSIP/Universal Images Group via Getty Images)
Researchers conducted a study to determine whether the addition of a default screening order in the electronic health record increases the rate of hepatitis C virus screening among hospitalized patients.

The inclusion of hepatitis C virus (HCV) screening as a default order in electronic health records (EHR) significantly increased the rate of HCV screening compared with conventional interruptive alerts, according to findings published in JAMA Network Open.

A randomized clinical trial was conducted at 2 academic hospitals at the University of Pennsylvania between June 2020 and April 2021. The goal of this study was to determine whether the addition of a default order (intervention) to the order set on hospital admission increases the rate of HCV screening compared with preexisting alerts (control) within the EHR. The intervention included a prechecked screening order that required clinicians to opt-out of the HCV screening ordering process. Hospitalized patients born between 1945 and 1965 with no history of HCV screening were included. The primary outcome was the percentage of eligible patients who underwent HCV screening.

This study comprised a total of 7634 patient encounters, with 3229 and 4405 in the intervention and control groups, respectively. The mean patient age was 65.4 years, 55.6% were men, 37.8% of patients had commercial health insurance, 51.7% had Medicare, and 32.0% vs 25.2% of patients in the intervention vs control groups were Black, respectively.

Among the 2 hospitals included (hospital A and hospital B), the rate of HCV screens ordered at baseline were 41.5% (95% CI, 39.1-43.9) for hospital A and 34.5% (95% CI, 31.6-37.4) for hospital B. Results of a fully adjusted model that controlled for patient age, sex, ethnicity, insurance, BMI, and Charlson comorbidity scores showed a statistically significant increase in the percentage of HCV screens ordered among patients in the intervention group vs those in the control group (38.1%; 95% CI, 36.1-40.0). Similar results were observed in regard to the increase in completed HCV screens among patients in the intervention vs control groups (31.8%; 95% CI, 29.7-33.8).

Overall, the intervention led to a 0.4% increase in the number of patients diagnosed with HCV infection (95% CI, 0.003-0.8; P =.06).

This study was limited by the difference in characteristics among the patients between the 2 hospitals, and the findings may not be generalizable to non-academic hospital settings.

According to the researchers, “these results could translate to expanded HCV screening among all adults and benefit other important clinical quality initiatives.”

Disclosure: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Mehta S, Torgersen J, Small D, et al. Effect of a default order vs an alert in the electronic health record on hepatitis C virus screening among hospitalized patients. JAMA Netw Open. Published online March 17, 2022. doi:10.1001/jamanetworkopen.2022.2427