An Electronic Health Record–based Intervention to Promote Hepatitis C Virus Testing Among Adults Born Between 1945 and 1965: A Cluster-randomized Trial. Issue 6 (June 2017)

• Record Type: Journal Article
• Authors: Federman, Alex D.; Kil, Natalie; Kannry, Joseph; Andreopolous, Evie; Toribio, Wilma; Lyons, Joanne; Singer, Mark; Yartel, Anthony; Smith, Bryce D.; Rein, David B.; Krauskopf, Katherine
• Is Part Of: Medical care. Volume 55:Issue 6(2017)
• Publication Date: 2017-06
• Subjects: hepatitis C screening -- electronic health records -- baby boomer birth cohort; Economics, Medical -- Periodicals; Insurance, Health -- Periodicals; Santé, Services de -- Administration -- Périodiques; Soins médicaux -- Périodiques; Medical economics -- Periodicals; Health insurance -- Periodicals; Medical economics -- United States -- Periodicals; Health insurance -- United States -- Periodicals; Comprehensive Health Care -- Periodicals; Personal Health Services -- Periodicals; Gezondheidszorg; Économie de la santé -- Périodiques; Santé, Services de -- Périodiques; Health insurance; Medical economics; United States; Periodicals; 362.10973
• DOI: 10.1097/MLR.0000000000000715
• Languages: English
• ISSNs: 0025-7079

Abstract

Abstract : Background: The Centers for Disease Control and Prevention (CDC) recommends one-time hepatitis C virus (HCV) antibody testing for "Birth Cohort" adults born during 1945–1965. Objective: To examine the impact of an electronic health record (EHR)-embedded best practice alert (BPA) for HCV testing among Birth Cohort adults. Design: Cluster-randomized trial was conducted from April 29, 2013 to March 29, 2014. Subjects and Setting: Ten community and hospital-based primary care practices. Participants were attending physicians and medical residents during 25, 620 study-eligible visits. Intervention: Physicians in all practices received a brief introduction to the CDC testing recommendations. At visits for eligible patients at intervention sites, physicians received a BPA through the EHR to order HCV testing or medical assistants were prompted to post a testing order for the physician. Physicians in control sites did not receive the BPA. Main Outcomes: HCV testing; the incidence of HCV antibody positive tests was a secondary outcome. Results: Testing rates were greater among Birth Cohort patients in intervention sites (20.2% vs. 1.8%, P <0.0001) and the odds of testing were greater in intervention sites after controlling for imbalances of patient and visit characteristics between comparison groups [odds ratio (OR), 9.0; 95% confidence interval, 7.6–10.7). The adjusted OR of identifying HCV antibody positive patients was also greater in intervention sites (OR, 2.1; 95% confidence interval, 1.3–11.2). Conclusions: An EHR-embedded BPA markedly increased HCV testing among Birth Cohort patients, but the majority of eligible patients did not receive testing indicating a need for more effective methods to promote uptake.