1. Building a Data Driven HCV Screening and Linkage-to-Care Program
A review of Norton Healthcare’s HCV screening program and our HCV+ patient population
Michelle Rose, MBA
Infectious Diseases/ Population Health Analyst
9/21/2018

2. Funded through a grant from Gilead Sciences:
Disclosure
Funded through a grant from Gilead Sciences:
Covers Project Manager, Patient Navigators, and up to 10% of Principal Investigator salary
EMR modifications
Grant funds do not extend past linkage-to-care
9/21/2018

3. Frontlines of Communities in the United States (FOCUS) Overview
Make routine HIV/HCV screening a standard of medical care
Reduce the number of undiagnosed individuals, decrease the number of those who are diagnosed late, and ensure linkage to care and treatment
Generate dialogue among healthcare systems on increasing HIV and viral hepatitis diagnoses
Change public perceptions, and overcome HIV- and viral hepatitis-related stigma that may discourage testing
9/21/2018

4. Norton pre-FOCUS HCV screening practices
6,882 screened
417 AB+
RNA+ est. < 100
Linkage to Care unknown
9/21/2018

5. Analyses objectives
Better understand the composition of our HCV+ patient population
Identify linkage-to-care opportunities and barriers and develop actionable strategies for moving patients along the care continuum
Identify data-driven opportunities for expanding HCV screening
9/21/2018

6. Year 1 data - 1 May 2016 and 30 June 2017 35,630 Screened 2,022 AB+
994 RNA+
First Quarter Year 1 Program Modifications:
EMR Primary Care Modification: CDC Birth Cohort Best Practice Alerts (BPA)
Quantitative PCR Reflex for all HCV AB+ screens
9/21/2018

7. Doctor’s name
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8. 9/21/2018

9. Screening by age groups: N=35,630
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10. Screening by sex and race: N =35,630
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11. Screens ordered by site: N=35,630
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12. AB+ and RNA+ by age group and sex: N=2,022
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14. HCV RNA+ patients by birth cohorts: N=994
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15. HCV seropositivity by: zip codes (with HCV highest rates) and birth cohort
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16. HCV seropositivity by: zip codes (with HCV highest rates) and birth cohorts
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17. HCV RNA+ patient status as of 1 Oct 2017: N=994
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19. Proportion of HCV+ patients reaching successive stages
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20. Actively followed by provider - age group and sex
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21. On or completed HCV treatment - age group and sex
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22. Deceased - adjusted age group and sex: N=63
Overdoses or Bacterial Infections
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23. Incarcerated - age group and sex: N=106
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24. HCV screening by site as a predictor of patient status
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25. HCV seropositivity rates outside of the CDC birth cohort were significant; screening only within the birth cohort (Baby Boomers) would have resulted in missing close to 50% of the HCV infections.
The BPA launched early in the study resulted in much higher rates of screening within the birth cohort. Norton should now consider an EMR modification that will significantly promote outpatient HCV screening of patients born after 1965.
Primary care providers played a crucial role in positively moving HCV+ patients along the care continuum. Providers that regularly engaged with their patients to get screened and subsequently linked to specialty care had the highest HCV cure rates.
9/21/2018

26. Leverage your influence as the PCP in HCV care, treatment and cure
Screen!!!!! within and outside of the Baby Boomer birth cohort
Reflex HCV positive antibody tests to quantitative PCR
Communicate RNA+ tests in person and provide patient appropriate HCV literature
Dedicate an HCV patient navigator
Expand HCV referrals to include Infectious Disease Specialists
Don’t take an initial No Thank You as a final No Thank You – perseverance matters
Coordinate care with treating HCV Specialists
Partner with a specialty pharmacy
9/21/2018

27. Bonus Slide
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28. HCV treatment approval by payor – top 10
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