Maine Medical Center, Medical Education, Maine Medical Center Research Institute, Internal Medicine, Center for Outcomes Research & Evaluation
Maine, Ambulatory Care Facilities, Mass Screening, Hospitals, Hepatitis C
Background: In the United States, an estimated 2.7 to 3.9 million people are living with hepatitis C virus (HCV) infection, and the current opioid epidemic is fueling nationwide increases in HCV prevalence. In 2016, the CDC reported more than 41,000 new infections nationally, which was a 21% increase from the 2015 report. According to the 2017 surveillance report by the State of Maine, the prevalence of HCV infection has increased by 243% since 2013 and over half of the cases were adults under age 30 years of age. Despite the availability of effective interferon-free, direct-acting antiviral (DAA) treatment options, very few people are aware of their diagnosis and an even smaller proportion of patients who are aware of their diagnosis are engaged in care. In this quality improvement project, we aim to 1) identify the gaps and barriers in the HCV cascade of care at Maine Medical Center (MMC) outpatient departments and 2) propose intervention strategies based on the findings to improve the HCV cascade of care at Maine Medical Center.
Methods: We will perform a retrospective analysis of data from patients eligible for HCV screening, who were seen at MMC outpatient departments (Bramhall and Westbrook internal medicine clinics) between May 2015 and May 2019. Eligibility for screening will be defined using CDC’s recommendation: birth between 1945 and 1965, treatment with dialysis, ALT level >35 for 6 months, or a diagnosis of injection drug use disorder. Our proposed outcome measures encompass the cascade of care from HCV screening to successful treatment; data analysis will be descriptive and we will calculate the proportion of patients identified at each level within this cascade.
Results: The MaineHealth IRB has approved our study and data analysis is pending. We will present the proportion of eligible patients who were screened for HCV and, among those screened, the proportion with confirmed HCV infection. Then, among those diagnosed with HCV, we will present the proportions linked to care, subsequently received treatment, and attained sustained virologic response.
Conclusions: We anticipate that this study will identify gaps in care for patients with previously undiagnosed HCV and will inform future intervention strategies for engagement in outpatient HCV screening and treatment at MMC.
Agmas, Wollelaw; King, Brian; Craig, Wendy; and Thakarar, Kinna, "A cascade of Hepatitis C screening and Care at Maine Medical Center Internal Medicine Clinics" (2020). Costas T. Lambrew Research Retreat 2020. 115.