An Electronic Health Record–based Intervention to Promote Hepatitis C Virus Testing Among Adults Born Between 1945 and 1965

A Cluster-randomized Trial

Bibliographic Data

ID9099360
AuthorsAlex D Federman (0000-0002-4824-064X, Icahn School of Medicine at Mount Sinai, corresponding author), Natalie Kil (Mount Sinai Health System, New York, NY), Joseph Kannry (0000-0002-6089-1488, Icahn School of Medicine at Mount Sinai, corresponding author), Evie Andreopolous (Icahn School of Medicine at Mount Sinai), Wilma Toribio (0000-0001-9936-7811, Icahn School of Medicine at Mount Sinai, corresponding author), Joanne Lyons (Mount Sinai Health System, New York, NY), Mark Singer (Mount Sinai Health System, New York, NY), Anthony Yartel (0000-0001-6586-9362, Centers for Disease Control and Prevention, Atlanta, GA), Bryce D Smith (0000-0002-7688-4602, Centers for Disease Control and Prevention, Atlanta, GA), David B Rein (0000-0002-1271-5789, NORC at the University of Chicago, Chicago, IL), Katherine Krauskopf (Valley Medical Group, Greenfield, MA)
Year2017
Volume55
Issue6
Pages590-597
Publication date2017-06-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000000715
PMID28288075
OpenAlexW2591942883
LanguageEN
Citations received3
References cited33

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

Cohort · Cohort study · Confidence interval · Family medicine · Hepatitis C · Hepatitis C virus · Incidence (geometry) · Medical record · Odds ratio · Virus · Diabetes Management and Education · Electronic Health Records Systems · Hepatitis C virus research · Immunology · Internal Medicine · Medicine · Pediatrics