Streamlining Screening to Treatment: The Hepatitis C Care Cascade in the Mid-Atlantic Region

Streamlining Screening to Treatment: The Hepatitis C Care Cascade in the Mid-Atlantic Region


Carla V Rodriguez, PhD; M Cabell Jonas, PhD; Kevin B Rubenstein, MS;
Yan Sun, MS; Michael Horberg, MD; Bernadette Loftus, MD

Introduction: In 2015, the Mid-Atlantic Permanente Medical Group implemented a hepatitis C virus (HCV) care cascade (pathway) to identify patients with HCV and close care gaps. We describe this pathway and evaluate whether HCV antibody screening has increased since its implementation. We also describe changes in confirmatory testing, genotyping, and patient follow-up over time.
Methods: The pathway included an automated screening alert for patients without evidence of a prior HCV antibody (Ab) test, reflex testing (HCV RNA, hepatitis B surface antigen, and HIV Ab) on stored samples of those patients testing HCV Ab positive, and coordinators to assist patients and to support clinical workflow. We used electronic health record data to retrospectively compare screening among patients visiting during a ten-month period before the pathway was implemented and a ten-month period since the pathway began. We followed each cohort for an additional six months to measure differences in HCV Ab, HCV RNA, HCV genotyping, and follow-up visits with gastroenterology or infectious diseases. We used a proportional hazards model to compare the time to HCV antibody screening across cohorts, adjusting for race, age, sex, neighborhood median income, medical specialty, number of visits in the prior year, patient address, and payer type. We describe proportions of patients receiving care measures downstream from the antibody result.
Results: The adjusted screening rate during the pathway era was 2.89 (95% CI 2.83-2.95) times higher than it was pre-intervention. Measures downstream from the antibody test also improved: HCV RNA confirmatory testing increased from 85% to 93% (p < 0.001); genotyping from 82% to 87% (p < 0.05); and specialty follow-up from 85%-94% (p < 0.001).
Discussion: HCV screening and subsequent care measures have increased since the implementation of the HCV care pathway.

etoc emailClick here to join the eTOC list or text TPJ to 22828. You will receive an Email notice with the Table of Contents of each issue.

The Permanente Journal advances knowledge in scientific research, clinical medicine and innovative health care delivery. It is a peer-reviewed journal of medical science, social science in medicine, and medical humanities.

The Permanente Press

The Permanente Press publishes The Permanente Journal and books related to health care. For information about subscriptions, missing issues, billing, subscription renewal, and back issues, Email:


27,000 print readers per quarter, 15,350 eTOC readers, and in 2018, 2 million page views of TPJ articles in PubMed from a broad international readership.


The Kaiser Permanente National CME Program designates this journal-based CME activity for 4 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ISSN 1552-5767 Copyright © 2019

All Rights Reserved.