‘Pathway code’ for HCV test orders improves screening, linkage to care

Implementation of a multifaceted hepatitis C care pathway improved screening and linkage to care rates, especially among baby boomers, or those born between 1945 and 1965.

“Our results add to existing evidence suggesting interventions that support the clinical workflow, such as electronic reminders, reflex laboratory testing and care coordination, improve key aspects along the HCV care continuum,” Carla Rodriguez-Watson, PhD, MPH, from the Mid-Atlantic Permanente Medical Group in Rockville, Maryland, and colleagues wrote in their study.

The researchers conducted an observational cohort study using electronic health records of patients seen at Kaiser Permanente Mid-Atlantic States during a pre-intervention period (June 2013 to September 2014) or a post-intervention period (March 2015 to May 2016).

They compared HCV antibody screening between the periods in subgroups defined by birth cohort, race, sex, and service area, and compared diagnosis communication using a unique “Pathway code” that included work orders for HCV Ab, reflex HCV RNA, HIV Ab, and hepatitis B surface antigen tests.

Annual prevalence of HCV screening increased by 100% from baseline to the end of the study. Using the Pathway code improved screening compared with the pre-intervention period (adjusted HR = 2.5; 95% CI, 2.46-2.55). HIV screening also improved (aHR = 2.05; 95% C, 1.74-2.43).

The Pathway code was most effective among patients born between 1945 and 1965 (aHR = 6.85; 95% CI, 6.65-7.05) and increased diagnosis communication among patients with positive HCV RNA results (aHR = 1.7; 95% CI, 1.45-2) and among those who had a single antibody test ordered (aHR = 3.34; 95% CI, 2.66-4.21).

“This analysis represents the first 16 months of the Pathway, which has since expanded screening alerts to men who have sex with men and patients reporting injection drug use,” Rodriguez-Watson and colleagues wrote. “The proportion of Pathway HCV antibody orders has increased since the end of the study to 50%. We expect further adoption will continue to close gaps along the care continuum. Future research is needed to track progress.” – by Talitha Bennett

Disclosures: Kaiser Permanente Community Benefit provided study funding. The authors are/were employees of the Mid-Atlantic Permanente Medical Group.