EMR system for HCV screening in ED may be beneficial

Nearly two-thirds of patients with chronic hepatitis C infection identified via risk-based screening in the ED attended a first appointment with a provider, researchers reported at The Liver Meeting Digital Experience.

“A streamlined EMR system for HCV screening and subsequent linkage to care from the ED can be successfully implemented,” Ji Seok Park, MD, from the Digestive Disease and Surgery Institute at Cleveland Clinic and the department of internal medicine at Englewood Health in New Jersey, said during a virtual poster presentation.

In April 2020, the CDC updated its previous risk-based HCV screening guideline to recommend universal screening. Before this change, however, Park and colleagues recognized that patients in the ED represent an ideal opportunity to screen patients who may otherwise not be screened for HCV.

“We implemented a risk-based screening program for ED patients and set up a system to facilitate linkage to care,” Park said during a virtual poster presentation.

The HCV screening algorithm was set to trigger an alert in the EMR system for certain patients who consented to testing, including baby boomers or patients with current or past injection drug use, history of naloxone administration in the field before arrival to the ED or in the ED or positive urine toxicology screening for opioids or cocaine. Positive samples were automatically screened for HCV RNA and patients with positive screening tests were contacted for confirmatory tests and to facilitate linkage to care.

Patients seen in the ED at Englewood Health from August 2018 to April 2020 were included in the study.

A total of 4,525 patients underwent screening tests, of whom 131 had positive antibodies and 43 were HCV RNA-positive on confirmatory tests, indicating that only 33% of patients with positive screening tests had chronic infection, Park said. Results also showed that the rate of chronic infection was higher among men vs. women (1.34% vs. 0.6%; P = .01).

The researchers also evaluated patients with a history of previous treatment for chronic HCV to assess the spontaneous clearance rate. They found that spontaneous clearance rates were lower in patients with vs. without a history of chronic opioid use (48.6% vs. 72% P = .015) and in patients with vs. without a history of tobacco use (56.6% vs. 80.5%; P = .01). Male sex was also related to worse spontaneous clearance rate, but this association was not statistically significant.

Among the 43 patients diagnosed with chronic HCV, 28 attended a first appointment with providers, with a linkage to care rate of 65.1%. Inability to contact patients after discharge from the ED was the most common barrier for linkage to care. Insurance types were also closely related to linkage of care, with patients without insurance failing to establish care despite efforts by patient navigators to make appointments at regional federally qualified health centers.

“Our findings emphasize the importance of strategic HCV screening for the vulnerable population and more focused resource distribution for uninsured patients,” Park said.