Kaiser Permanente Screening Model Improves Detection of Hepatitis C

More than a million Americans may benefit

A new screening approach developed by Kaiser Permanente has been shown to close gaps in diagnosis and care for patients with hepatitis C virus (HCV) infection, according to new research published in Clinical Infectious Diseases. The screening protocol could improve disease detection for the more than 1.5 million Americans who do not know they are chronically infected with the virus, the authors say.

Three to four million individuals in the United States are chronically infected with HCV, according to the National Health and Nutrition Examination Survey. However, an estimated 50% to 80% of those individuals are unaware of their infection, increasing both the likelihood that they will develop liver damage and the chances that they will infect others. If left untreated, approximately 50% of those with chronic HCV infection will develop liver cirrhosis, and 33% will die from liver-related complications. Screening is recommended for all at-risk patients, including individuals with human immunodeficiency virus (HIV) or patients on kidney dialysis, and those born between 1945 and 1965. 

“Chronic hepatitis C is a slowly progressing disease that is relatively asymptomatic until severe liver disease develops, which is why it is important to identify patients who may be at risk so we can coordinate timely treatment,” said Michael Horberg, MD, executive director of research at the Mid-Atlantic Permanente Medical Group. “Our study shows the value of a comprehensive program to assist hepatitis C patients through each step of the care process, from screening to detection and monitoring.”

In October 2014, Kaiser Permanente of the Mid-Atlantic States launched a comprehensive HCV screening model designed to improve the detection and treatment of the virus. The model has five primary components:

  • An automated electronic medical record best-practice alert to notify providers that patients are recommended for hepatitis C screening because they were born between 1945 and 1965 or because they are identified as being at risk for the virus.
  • Automated confirmatory laboratory testing for any patient who tests positive for the HCV antibody to determine whether the person has an active infection.
  • A hepatitis C care coordinator to assist in ordering follow-up labs, scheduling liver damage testing, and informing patients of their infection status.
  • Integration into the screening process of a noninvasive, pain-free test for measuring liver damage.
  • Connection of patients to physicians for ongoing care.

Between October 2014 and July 2015, 11,200 patients were screened using the new protocol.

In the new study, the researchers found:

  • A total of 3.3% tested positive for the HCV antibody, and 100% of antibody-positive patients received subsequent HCV RNA testing.
  • Of those patients who tested positive for the HCV antibody, 76% had chronic HCV infection; 81% of these patients underwent the noninvasive test to measure liver damage.
  • A diagnosis of HCV infection was communicated to 94% of the patients.

To date, more than 30,000 patients in mid-Atlantic states have been screened for HCV infection using the new protocol.

“As with any chronic disease, it is important to take a coordinated approach to care. There are many aspects of the Kaiser Permanente protocol that can be replicated by independent physicians or health systems,” noted lead author M. Cabell Jonas, PhD. “The new hepatitis C care pathway enables broad screening in an efficient manner to ensure we are providing care to those who need it the most.”

Source: Kaiser Permanente; April 5, 2016.