EMR alerts | | | | | | |
Outpatient | | | | | | |
Jones (2017) | Abstract | Retrospective chart review | Patients born between 1945-1965 not previously screened for HCV | Baylor Scott & White in Central Texas Primary Care Clinic from 2/2014-2/2015 | n>30,000 | Statistically significant increase in baby-boomer screening for hepatitis C from 1.87% prior to EMR reminder to 14.14% after initiation of the reminder |
Kahn (2018) | Abstract | Retrospective chart review | Patients born between 1945-1965 not previously screened for HCV | Northshore University Health System; Implemented 7/2017 | n=99892 | HCV tested: 13.8% (13,804/99,892) Highly varied adherence to screening guidelines by PCPs |
Konerman (2017) | Abstract | Retrospective cohort study | Patients born between 1945-1965 without prior diagnosis of HCV infection, no prior documented anti-HCV testing | Primary care clinics | n=52,5660 | HCV screening increased 10-fold from 7.6% for patients with PCP visit in 6 months prior to BPA implementation to 72% over a 1-year period after implementation |
Soo (2017) | Abstract | Retrospective chart review | Patients born between 1945-1965. Excluded patients with HCV on problem list or if they had their one-time HCV screen | Automatic health maintenance alert in an integrated medical group, 6/2015-6/2016 | n=29,987 | HCV screening rate increased from baseline 13.3% to 15.6% after 1 month and to 40.2% after 12 months HCV Ab-positive: 2.3% (684/29987) |
Soo (2018) | Abstract | Prospective cohort | Patients born between 1945-1965. Excluded patients with HCV on problem list based on ICD9/10 code or positive anti-HCV or HCV RNA | Automatic health maintenance alert module at primary care practices in the Providence Health and Services and rates assessed monthly in five regions in the Western USA, 1/2017 - 12/2018 | n=76288 | HCV Ab-positive: 4.6% (3507/76,288); HCV screening rate increased 31.9% from 23.0% to 54.9% |
Teply (2018) | Abstract | Retrospective chart review | All patients born between 1945-1965 seen at a primary care clinic within a regional healthcare system in Midwest USA | 35 primary care clinics within a regional healthcare system in Midwest USA (prealert), 6/1/2016-11/30/2016; (postalert) 12/1/2016-5/31/2017 | n=29,703 (pre), 29,913 (post) | Prealert HCV tested: 1.62% (482/29.703) HCV Ab-positive: 4.2% (20/482) Postalert HCV tested: 19.0% (5685/29,913) HCV Ab-positive: 1.9% (107/5685) 10-fold increase in HCV screening |
Al-Hihi (2017) | Full-text | Prospective cohort- 2 PDSA cycles | All patients born between 1945-1965 seen in a primary care clinic | Multiphysician practice in the Midwest USA representing 84 faculty physicians and residents, 6/2016-3/2017, with BPA and health maintenance alerts in the EMR and education to primary care providers via single educational sessions with a hepatologist | Not reported | Baseline screening rate preintervention: 30% (1674/5541) Screening rate at 3 mo: 45% Screening rate 3 mo after concurrent education session: 55% |
Federman (2017) | Full-text | Randomized control trial | Patients born during birth cohort period were subjects. However, attending physicians and medical residents were participants in the study to see how BPA affected HCV testing and incidence of HCV Ab-positive tests | 10 community and hospital-based primary care practices that implemented BPA for HCV testing among birth cohort adults, 4/2013-3/2014 | n=25, 620 study-eligible visits | Testing rates greater among Birth Cohort pts in intervention sites (20.2% v 1.8%, p<0.0001) EHR-embedded BPA markedly increased HCV screening, but the majority of eligible pts did not receive testing indicating a need for more effective methods to promote uptake |
Nitsche (2018) | Full Text | Case control | Patients born between 1945-1965 | 7 primary care sites in Virginia Mason Healthcare System (greater Seattle area, WA), 8/1/2014-9/14/2015 with 3 sites given additional education interventions (case) not provided to the remaining 4 (control) | n=73,685; cases 37,783; controls 35,902 | Screening rates at the following times (case vs. control), p<0.001 at all time points Baseline: 6.1% vs. 4.6% Time 1: 18.1% vs. 10.4% Time 2: 20.3% vs. 12.5% Time 3: 22.2% vs. 13.7% Time 4: 23.4% vs. 14.7% Time 5: 24.2% vs. 15.3% Time 6: 17.5% vs. 10.4% |
Shahnazarian (2015) | Full-text | Case control | Patients born between 1945-1965 | Methodist Hospital in Brooklyn, NY prelegislative mandate (12/2013) and postmandate and postEMR intervention, 5/2014-2/2015 | Not reported | PreEMR alert HCV screen: 47.2% PostEMR alert HCV screen: 87.9% |
Yeboah-Korang (2018) | Full-text | Case control | Patients born between 1945-1965 in the outpatient setting | Northshore University Health System, 1/2010 to 12/2015, with retrospective chart review back to 2003 to identify overall HCV testing rates (case) and then during 7/2015; BPA alert implemented 7/2017-11/2017 | n=10,089 (pre); 45,188 (post) | PreEMR alert HCV screen: 0.68% (69/10,089) PostEMR alert HCV screen: 10.76% (5451/45,188) 15.8-fold increase in HCV testing rates |
Inpatient | | | | | | |
Mehta (2017) | Abstract | Retrospective cohort | Adult admitted to inpatient medicine service born between 1945-1965 | 9/2014-9/2016 | n=1128 | HCV Ab-positive: 9.6% (108/1128) HCV-positive: 52% (56/108) HCV RNA PCR-positive : 21% HCV RNA PCR-negative: 25% HCV RNA PCR not performed during hospitalization: 54% Only 18% of seropositive had outpatient gastrointestinal follow-up |
Shen (2018) | Abstract | Retrospective cohort | Patients born between 1945-1965 categorized by 3 timeframes (premandate, postmandate but prereflex RNA, postreflex RNA) and stratified by screened vs not screened | Patients admitted to New York Presbyterian Hospital- Weill Cornell; data collected in 3 times frames: 1. Premandate (1/2013-12/2013) 2. Postmandate but prereflex (1/2014-8/2015) 3. Postreflex RNA (9/2015-12/2016) | n=51657 | Overall and initial screening improved pre- and postmandate from 8% to 39% and 53% to 84% (p<0.01); this did not translate into improved linkage to care Follow-up care and initiation of treatment decreased from 31% to 20% and 9% to 5%, (p<0.01) |
Turner (2015) | Full-text | Prospective cohort | Patients born between 1945-1965 admitted to hospital | Safety-net hospital in South Texas from 1/2012-1/2014 with follow-up through 12/2014 | n=6140 | HCV tested: 51% (3168/6140) HCV Ab-positive: 7.6% (240/3168) HCV RNA-positive: 63% (134/214), 4.2% overall chronic HCV: 96.3% (129/134) were counseled and 80.6% (108/134) received primary care follow-up and 38.8% (52/134) received hepatology follow-up with 5 initiating anti-HCV treatment |
Direct patient solicitation- phone call, mailing | | | | |
Trowell (2018) | Abstract | Prospective cohort | Patients born between 1945-1965 chosen from a population in a Baltimore city hospital | Two-pronged approach: 1. BPA created in EMR to prompt PCP to order tests for patients; 2. Letters mailed with educational material, blood test request forms for pts without prior HCV testing | n=15,583 | BPA screened 8786/15,583 Letters screened 3645/15,583 Screened via hospital or other affiliated locations 3152/15,583 HCV Ab-positive: 2.7% (426/15,583) HCV RNA-positive: 1.3% (204/15,583) HCV positivity rates highest in 1951-1960 birth cohort |
Kruger (2017) | Full Text | Prospective cohort | Project managers of each of the three sites implementing HCV screening per CDC recommendation (BEST-C sites). Filled out standardized questionnaires about their implementation experiences and qualitative analysis | Three sites implemented interventions to increase birth-cohort testing through participation in the Birth-cohort Evaluation to Advance Screening and Testing for Hepatitis C from 12/2012-3/2014 | Not reported | BPA was the preferred intervention at all three sites, but site-specific challenges prevented success of the solution in two out of three sites Despite challenges in start-up of the screening in PCP settings, it was deemed feasible and likely successful given dedicated resources, buy-in, and support from hospital administration |
Yartel (2018) | Full-text | Randomized control trial | Patients born between 1945-1965 not previously screened or diagnosed | Patients randomly assigned to receive one of three independent implementation strategies (repeated mailing outreach, BPA, direct patient solicitation), 12/2012-3/2014 | n=8992 (mailing trial) n=14,475 (BPA trial) n=8873 (patient solicitation trial) | Repeated mailing-intervention was 8 times as likely to identify anti-HCV-positive (adjusted relative risk: 8.0, 95% confidence interval: 2.8-23.0; adjusted probabilities: intervention 0.27%, control 0.03%) BPA trial was 2.6 times as likely to identify anti-HCV-positive (adjusted relative risk 2.6, 95% confidence interval: 1.1-6.4; adjusted probabilities: intervention 0.29%, control 0.11%) Patient-solicitation trial was 5 times as likely to identify anti-HCV-positive (adjusted relative risk 5.3, 95% confidence interval: 2.3-12.3) |
Colonoscopy | | | | | | |
Abu-Heija (2018) | Abstract | Retrospective chart review | Dominantly African American adults undergoing colonoscopy born between 1945-1952, subgroup analysis with university physician group or outsider provider | Urban open access colonoscopy suite, 2014 | n=444 | HCV tested: 140/444 HCV Ab-positive: 43% (60/140) HCV RNA PCR-positive: 94% (56/60) university physician group vs. non- university physician group tested: 48% vs. 15% (p<0.05) Lost to follow-up after first visit: 47% |
Abu-Heija (2019) | Abstract | Retrospective chart review | Dominantly African American adults undergoing colonoscopy born between 1945-1958 | Urban open access colonoscopy suite in 2014 or 2017 | n=988 | HCV tested: 40.3% (2017) vs. 31.5% (2014) (p=0.005); no difference based on race or gender HCV Ab-positive: 31.5% (2017) vs. 42.9% (2014) HCV RNA PCR-positive: 97% (2017) vs. 96.5% |
Matin (2018) | Abstract | Prospective cohort | Veterans undergoing colonoscopy, registered nurse screen day prior and if no prior screen for HCV and born between 1945-1965, verbal consent obtained over the phone, HCV tested when intravenous line placed | Veterans Affairs facility, 7/2017- 10/2017 | n=208 (38 did not show for appointments) | HCV tested: 145/170 (85%) |
Sears (2013) | Full-text | Prospective cohort | Adults aged 50-65 years-old who received a colonoscopy answered questions in a survey and blood samples were collected for hepatitis B virus and HCV | 3 month period | n=500 | HCV tested: 72% (376/500) HCV Ab-positive: 4/376 HCV RNA PCR-positive: 1/4 |
Endoscopy | | | | | | |
Hirode (2018) | Abstract | Prospective cohort | Adults undergoing outpatient endoscopy categorized into: 1) BC and at least one RF 2) BC and no RF 3) non BC with one RF | Urban safety-net hospital, 7/2015-7/2017 | n=1752 | Acceptance of test: BC-RF+ > BC+RF- > BC+RF+ Overall HCV Ab-positive: 3.4% BC+ RF+: 12.5% BC- RF+: 4.9% BC+ RF-: 1.3% -higher in US born patients |
Hirode (2019) | Abstract | Observational | Outpatient endoscopy-based patient navigator model for adults undergoing endoscopy | Urban safety-net hospital, 7/2015-9/2018 | n=3624 | Eligible for HCV screening (69.2%) based on: BC: 89.8% At least 1 HCV RF: 30.4% Eligible patients tested increased from 50.8% to 77.9% |
Wong (2017) | Abstract | Prospective cohort | Adults undergoing outpatient endoscopy | Underserved safety-net hospital, 7/2015-6/2016 | n=1125 | Trend towards lower HCV test acceptance among BC (odds ratio 0.39, 95% confidence interval: 0.13-1.14) High risk (including BC): 66.5% HCV test accepted: 85.4% |
ED | | | | | | |
Hyun (2017) | Abstract | Prospective cohort | Adults born between 1945-1965 presenting to ED using streamlined EHR ordering with patient navigators contacting individuals with confirmed infection by automated certified letters and phone calls for linkage to care | ED of community hospital, 2/2016- 1/2017 | n=12,617 | HCV tested: 40.2% (5069/12617) HCV Ab-positive: 3.99% (202/5069) HCV RNA PCR-positive: 1.32% (67/5069) Linkage of care rate 37.3% in 6 month period patient navigation; awareness of infection in chronically infected but not engaged in care: 38.8% (26/67) |
Minhas (2019) | Abstract | Retrospective cohort | Adults born between 1945-1965 presenting to ED with testing conducted on an opt-out basis (2/2017-11/2017) then when notification was no longer required on all-comers (11/2017-1/2018) with referral to affiliated hepatology clinic | ED of urban hospital, 2/2017-1/2018 | n=1525 | HCV Ab-positive: 15.5% (237/1525) HCV RNA PCR-positive: 67.9% (161/237) Referral to hepatology: 75% (121/161) |
Allison (2016) | Full-text | Cross sectional | Adults born between 1945-1965 presenting to ED were provided study information sheet and CDC information sheet in HCV testing in baby boomers, then participated in researcher-administered questionnaire, those with positive HCV Ab were referred to clinic, non-attendance resulted in telephone call | ED of a large urban academic hospital (Bellevue, WA) in a state where birth cohort is mandated by law in all non-ED healthcare settings, 10/2014-7/2015 | n=915 | Structured interview: 46.7% (427/915) HCV tested: 90.0% (383/427) HCV Ab-positive: 7.4% |
Cornett (2018) | Full-text | Retrospective cohort | Adults born between 1945-1965 presenting to ED with an opt-out test order generated by the EHR seen between 11am-7pm and given handout explaining rationale with plan for contacting patients with results | ED of small urban/suburban area tertiary care academic hospital, 6/2016-12/2016 | n=3046 | HCV tested: 96.1% (2928/3046) HCV Ab-positive: 6.6% (192/2928) HCV RNA PCR-positive: 43% (71/167) |
Galbraith (2015) | Full-text | Cross sectional | Adults born between 1945-1965 presenting to ED with an opt-out as part of standard clinical care, therefore no informed consent was required with ED nurses screening using questionnaire embedded in the EHR with informational packet given to HCV-positive individuals and linkage to care specialist information with coordinator arrange follow-up and phone call follow-up | ED of a large academic urban hospital (UAB) in a socioeconomically disadvantaged population, 9/2013-11/2013 | n=3170 | Unaware of HCV status: 73.2% (2323/3170) Opted out: 12.7% (289/2323) Automated test order: 87.3% (1988/2323) HCV tested: 76.9% (1529/1988) HCV Ab-positive: 11.1% (170/1529) HCV RNA tested: 88.2% (150/170) HCV RNA PCR-positive: 68.0% (102/150) |
Hsieh (2016) | Full-text | Retrospective cohort identity unlinked seroprevalence | Adults aged >17 years-old presenting to a large academic urban hospital ED with excess blood specimen | ED of a large academic urban hospital (JHU) in a socioeconomically disadvantaged population, 6/2013-8/2013 | n=4713 | HCV Ab-positive: 13.8% (652/4713) Undocumented HCV infection: 31.3% (204/652) Diagnosed by BC: 48.5% (99/204) Diagnosed by RF: 26.5% (54/204) |
Lyons (2016) | Full-text | Cross sectional seroprevalence | Adults between the ages of 18-64 presenting to the ED were consented to a “study of disease of public health importance” and given compensation, risk factors assessed via health questionnaires, deidentified data | ED of urban academic hospital, 1/2008-12/2009 | n=1034 | HCV tested: 89% (924/1034) HCV Ab-positive: 14% (128/924) HCV RNA PCR-positive: 81% (103/128) Birth cohort only testing would have missed 28% (36/128) HCV Ab-positive, 25% (26/105) HCV RNA-positive Awareness of prior diagnosis: 32% (41/128) |
Schechter-Perkins (2018) | Full-text | Descriptive | Individuals >13 years-old of age presenting to the ED undergoing phlebotomy for clinical purposes, non-targeted, opt-out screening with a best practice advisory alert with navigators to facilitate linkage to care for those with positive RNA | ED of urban academic hospital (BMC), 11/2016-1/2017 | n=3936 | HCV tested: 3808 HCV Ab-positive: 13.2% (504/3808) HCV RNA PCR-positive: 59.2% (292/493) Outside BC with active infection: 54% (115) Linkage to care: 76.4% (223) Appointments scheduled: 38% (102) Attended LTC visit: 22.5% (66) |
White (2016) | Full-text | Retrospective cohort | Adults born between 1945-1965 or reporting any use of injection drugs who were not known to be HCV-positive to triage nursing, EMR, with opt-out testing requiring consent with physicians able to choose testing at clinical discretion (diagnostic) with informational packets sent to HCV-positive patients with referral to primary care which could then be canceled if RNA test was negative | ED of Highland Hospital-Alameda Health System, single-center urban ED, 4/2014-10/2014 | n=26639 | HCV tested: 9.7% (2581/26,639) HCV Ab-positive: 10.3% (267/2581) Screening Ab test: 79% (2028/2581) Diagnostic Ab test: 21% (553/2581) Screening HCV Ab-positive: 9.1% (185/2028) Diagnostic HCV Ab-positive: 14.8% (82/553) |
Non-physician providers | | | | |
Shelgrove (2018) | Abstract | Prospective cohort | Patients born between 1945-1965 in Yuba, Sutter, Colusa Counties. Also included patients ages 18-64 years-old in Butte, Glenn, Tehama Counties. Patients with high risk factors. Followed HCV Ab testing with reflex HCV RNA testing by PCR | Ampla Health (a Federally Qualified Health Center) offering medical, dental, mental health, specialty healthcare services in Northern California, screening from 8/2017-4/2018 | n=5481 | Detected HCV Ab seropositivity in 7.5% (410/5481). 45% (183/410) RNA-positive. Overall, 3.3% RNA-positive which averages to 20 HCV diagnosed patients/month HCV Ab-positive: 7.5% (410/5481) HCV RNA-positive: 45% (183/410) HCV RNA-positive overall: 3.3% (183/5481), average of 20 HCV diagnosed patients /month RNA-positive HCV reflex testing lead to timely diagnosis and LTC Patients attending follow-up appointment: 92% (168/183) |
Travis (2018) | Abstract | Retrospective chart review | Patients born between 1945-1965 | Emory Midtown University Primary Care Clinic, 12/1/2015-5/1/2018. Implemented “HCV screen” on patient intake form on 12/1/2016. | n=10,803 | HCV screening rates increased after intervention. Before intervention was 5% (232/4336). After intervention screening rates went to 18% (765/3498) in 2016-2017 and 23% (880/2969) in 2017-2018. |
Dong (2017) | Full-text | Prospective cohort | Patients in California in BBBC, high risk patients with hx of IVDU, crack cocaine or methamphetamine use. | Community pharmacy-based HCV-Ab POC screening program in California in collaboration with the local public health department. 3 month pilot, 6 community pharmacists. | n=83 | HCV-Ab rapid POC-positive: 1.2% (1/83) |