Hcv Testing Pattern Improvements after New Universal Screening Ehr Alert Implementation at a Large Healthcare System

ABSTRACT

Background: Screening for HCV is the first critical decision point for preventing morbidity and mortality from HCV cirrhosis and hepatocellular carcinoma, and will ultimately contribute to global elimination of a curable disease. This study aims to portray the changes over time in HCV screening rates and the screened population characteristics following the 2020 implementation of an EHR alert for universal screening in the outpatient setting in a large healthcare system in the US mid-Atlantic region. Method(s) Data was ed from the EHR on all outpatients from 1/1/2017 through 10/31/2021, including individual demographics and their HCV antibody screening dates. Mixed effects multivariable regression analyses were performed to compare the timeline and characteristics of those screened and un-screened for a limited period from 1/1/2020 to 10/31/2020 and centered on the EHR alert implementation. Result(s) Absolute number of screens increased by 103% after the implementation of the EHR alert. When comparing the five-month period before and after the EHR alert, the odds of being screened at an outpatient visit increased by 62% from 17 to 27 screens per 1,000 outpatient visits. Also during this time period, patients with Medicaid were more likely to be screened than private insurance (ORadj 1.10, [CI95 1.05, 1.15]), females more likely than males (1.26, [1.20, 1.32]);Black race more than White (1.59, [1.53, 1.64]);while those with Medicare were less likely than private insurance (0.62, [0.62, 0.65]). Over the entire 58-month period, the HCV Ab positivity rate decreased from 4.2% to 1.5%. Conclusion(s) Implementation of a universal HCV screening EHR alert was followed by a large increase in absolute screens and screening rates in the outpatient setting, despite the concurrent onset of the COVID-19 pandemic. These findings support that such an alert could play a crucial role in identification and subsequent elimination of HCV. Females, Black race and Medicaid patients were screened at higher rates, suggesting possible bias toward certain groups. Targeted testing in addition to universal screening remains a need despite much higher screening rates -expectedly, the proportion screened decreased, however the absolute number of HCV positive individuals decreased over time (data not shown). Our findings suggest that an EHR alert for universal screening could play a crucial role as the first step in identification and then elimination of HCV.