Increased HCV Screening Yields Discordant Gains in Diagnoses Among Urban and Rural Veteran Populations in Texas: Results of a Statewide Quality Improvement Initiative

摘要

Background: Chronic hepatitis C virus (HCV) infection is a significant health burden among military veterans. Our goalswere to increase monthly HCV screenings, diagnoses, and sustained virologic responses (SVR) among 88,652 unscreenedbirth cohort Veterans in Texas.Methods: The interventions were enabled within six of the eight healthcare systems (HCSs) that compose Veteran’s Inte-grated Service Network 17. The remaining two HCSs served as controls. The HCSs were separated into two groups: urbanand rural; each composed of a control and three interventional HCSs. Decision support programming was embedded withinthe Computerized Patient Record System that prompted HCV screening among previously unscreened birth cohort patients.Clinical process design and educational efforts were enacted to enhance treatment capacity.Results: Monthly screenings increased 4.89 times ( p < 0.001) and 2.97 times ( p < 0.001) during the postinterventionalperiod relative to control for urban and rural HCSs, respectively. For urban HCSs, diagnoses increased 1.58 ( p < 0.001)times more than the control group during the postinterventional period, but there was no difference in number of diagnosesin the rural HCSs ( p = 0.86). Monthly SVR increased 2.69 times more than the control group during the postinterventionalperiod ( p < 0.001).Conclusion: Decision support improved HCV screening among birth cohort patients in both urban and rural HCSs.Increased screening boosted the monthly number of diagnoses in the urban HCSs, but not in the rural HCSs; which rebutsthe utility of birth cohort screening among rurally residing veterans. These interventions significantly improved the rate ofSVR achievement relative to control.