Quality Improvement Measures in Hepatitis C Screening in an Inner City Health Clinic: Year over Year Results: 897

Introduction: For two years, New York State has mandated, with few exceptions, that medical providers offer hepatitis C (HCV) screening to all patients born between 1945 and 1965. As practitioners in a government supported, inner-city community health clinic treating an underserved population, we have undertaken quality improvement/quality assessment (QA/QI) measures to determine how our facility is performing, and identified several areas for improvement in treatment and management related to HCV. Methods: A search of our electronic medical record (E-Clinical Works) for all patients born 1945-1965 seen at our facility between 1/1/2015 and 12/31/2015 with no prior HCV data on record identified appropriate subjects. We then determined whether any testing for HCV was performed, and if positive, whether a follow up viral load and genotyping was performed. We also assessed whether newly diagnosed patients with HCV were screened and/or vaccinated for hepatitis A and B (HAV/HBV) immunity as well as HIV coinfection. We also determined the total number of patients treated with direct acting antivirals. Results: Of the 1168 patients in the target age-range seen during 2015 that were not previously screened for HCV, 35.7%, (417) were screened for HCV antibodies. Of those screened, 7.7% (32) tested positive. 88% (28) of these patients had a viral load sent, and of those with positive viral loads (16), 56% (9) had genotyping. The most common genotype seen was 1a. HAV/HBV serology was either checked or previously known on 88% (14) of HCV infected patients. HIV status was known for 63% (10) of HCV infected patients. Conclusion: This study builds on initial QA data obtained in the previous calendar year, and shows an increase in our HCV screening rate from 25% to 35%, which may be reflective of awareness among practitioners relating to the posted guidelines in all exam rooms. Our rate of obtaining viral loads was much the same as in prior years, and our rate of genotyping decreased somewhat from 77% to 56%, as did our screening for coinfection with HIV, from 88% to 63%. We increased our number of infections treated, with 15 patients receiving DAAs, up from 3 in 2014, likely due to increased Medicaid coverage. Although our screening rate has improved, we believe that further interventions such as POC testing and practice alerts may help further increase our screening rate, and that instituting an order set for positive screens will help ensure further improvements in coinfection and HAV/HBV screening.