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Implementing hospital‐based baby boomer hepatitis c virus screening and linkage to care: Strategies, results, and costs
Author(s) -
Turner Barbara J.,
Taylor Barbara S.,
Hanson Joshua T.,
Perez Mary Elizabeth,
Hernandez Ludivina,
Villarreal Roberto,
Veerapaneni Poornachand,
Fiebelkorn Kristin
Publication year - 2015
Publication title -
journal of hospital medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.128
H-Index - 65
eISSN - 1553-5606
pISSN - 1553-5592
DOI - 10.1002/jhm.2376
Subject(s) - medicine , baby boomers , hepatitis c virus , hepatology , cohort , hepatitis c , ambulatory , ambulatory care , family medicine , pediatrics , health care , immunology , virus , demographic economics , economics , economic growth
BACKGROUND/OBJECTIVE The US Preventive Services Task Force recommends 1‐time hepatitis C virus (HCV) screening of all baby boomers (born 1945–1965). However, little is known about optimal ways to implement HCV screening, counseling, and linkage to care. We developed strategies following approaches used for HIV to implement baby boomer HCV screening in a hospital setting and report results as well as costs. DESIGN/PATIENTS Prospective cohort of 6140 baby boomers admitted to a safety‐net hospital in South Texas from December 1, 2012 to January 31, 2014 and followed to December 10, 2014. PROCEDURES/MEASUREMENTS The HCV screening program included clinician/staff education, electronic medical record algorithm for eligibility and order entry, opt‐out consent, anti‐HCV antibody test with reflex HCV RNA, personalized inpatient counseling, and outpatient case management. Outcomes were anti‐HCV antibody‐positive and HCV RNA–positive results. RESULTS Of 3168 eligible patients, 240 (7.6%) were anti‐HCV positive, which was more likely (P < 0.05) for younger age, men, and uninsured. Of 214 (89.2%) patients tested for HCV RNA, 134 (4.2% of all screened) were positive (chronic HCV). Among patients with chronic HCV, 129 (96.3%) were counseled, 108 (80.6%) received follow‐up primary care, and 52 (38.8%) received hepatology care. Five patients initiated anti‐HCV therapy. Total costs for start‐up and implementation for 14 months were $286,482. CONCLUSIONS This inpatient HCV screening program diagnosed chronic HCV infection in 4.2% of tested patients and linked >80% to follow‐up care. Yet access to therapy is challenging for largely uninsured populations, and most programmatic costs of the program are not currently covered. Journal of Hospital Medicine 2015;10:510–516. © 2015 Society of Hospital Medicine