The Hepatitis C Care Cascade: Increasing Comprehensive Screening and Diagnosis


M Cabell Jonas, PhD; Michael Horberg, MD; Jacquelyn Redd, MD;
Dana Sloane, MD; Eric Wollins, MD; Carla Rodriguez, PhD;
Bernadette Loftus, MD

Abstracts from the Kaiser Permanente 2019 National Quality Conference

From Mid-Atlantic States

Background: Chronic hepatitis C is the most common US blood-borne infectious disease, affecting the large baby boomer-age population (born 1945-1965) and those at-risk because of blood exposure. Hepatitis C virus (HCV) kills more Americans than any other infectious disease. Significant gaps persist for screening, diagnosis, triage to care, and curative treatment.
Methods: The Kaiser Permanente Mid-Atlantic States (KPMAS) HCV Pathway is a technology-driven, coordinator-supported process to screen at-risk patients for HCV chronic infection (initial testing with HCV antibody, confirmed by HCV RNA), coinfection testing, liver assessment (including staging), and physician referral. The multistep pathway closes patient care gaps, improves quality, and eliminates unnecessary physician work.
Results: The HCV Pathway has improved regional screening rates, increased the percentage of total baby boomers screened, and improved testing quality across the testing cascade (including HCV RNA testing, coinfection testing, HCV genotype testing, and liver stiffness assessment).
Discussion: Modeling studies in the literature indicate programs that simultaneously address multiple points along the HCV care cascade result in better outcomes and higher value than interventions that target single steps. Broader implementation of a multistep technology and coordinator-assisted HCV Pathway, such as the KPMAS program, can improve regional HCV screening rates (particularly among the at-risk baby boomer-age population), can improve HCV testing efficiency (and coinfection testing), and can link patients to care more consistently. Resources are available to spread this program to other sites.

Abstracts from the Kaiser Permanente 2019 National Quality Conference


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