title: The performance of process measures in hepatitis C.
abstract: OBJECTIVE
  Previous evaluations regarding the extent to which standard chronic hepatitis C virus (HCV) care processes are delivered during routine clinical care are scant and have primarily relied on automated data--the validity of which is unknown.
  
  
  METHODS
  We examined adherence to 24 explicit modified Delphi panel-derived HCV-specific process measures in a cohort of 122,744 patients enrolled in the automated Veterans Administration HCV Clinical Case Registry between 2000 and 2006. We reviewed medical charts of 717 patients to compare the agreement between Registry and charts. We also estimated the effect of justifiable exceptions on measured performance in HCV by determining the proportion of patients who failed a measure but met a valid exception (i.e., patient refusal, outside care, or treatment contraindications).
  
  
  RESULTS
  The percentage of patients who met the individual measures varied. For example, 74% of patients received HCV genotype testing, 23% received antiviral treatment, 28% received liver biopsy, and 16% received hepatitis A vaccination. We found excellent agreement between the Registry and charts in all measures (agreement coefficients >0.75). However, exceptions to indicated care documented in charts were common for genotype testing, liver biopsy, and antiviral treatment. After accounting for these exceptions, the measure rates increased from 75 to 93% for genotype testing, 31 to 50% for liver biopsy, and from 26 to 64% for antiviral treatment. Treatment contraindications were the most common reasons for not meeting indicated care.
  
  
  CONCLUSIONS
  Automated data missed several exceptions to care that are documented only in providers' notes, thus underestimating process of care. These results have implications for future quality assessment initiatives-most of which will likely rely on automated data for process-based quality reporting. After accounting for automated data and medical record reviews, vaccinations and antiviral treatment rates in the Veterans Administration left room for improvement.
authors: Department of Gastroenterology and Hepatology, John Cochran VA Medical Center, St Louis University, St Louis, Missouri, USA. fasiha.kanwal@va.gov
authors: Fasiha
authors: F
authors: Kanwal
authors: Tuyen
authors: T
authors: Hoang
authors: Jennifer
authors: J
authors: Kramer
authors: Timothy
authors: T
authors: Chrusciel
authors: Hashem
authors: H
authors: El-Serag
authors: Jason A
authors: JA
authors: Dominitz
authors: Steven M
authors: SM
authors: Asch
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage; D001706:Biopsy / Q000706:statistics & numerical data; D000075202:Contraindications; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D005838:Genotype; D019698:Hepatitis C, Chronic / Q000175:diagnosis* / Q000188:drug therapy / Q000628:therapy*; D006801:Humans; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data*; D008875:Middle Aged; D017064:Process Assessment, Health Care; D019984:Quality Indicators, Health Care; D012042:Registries / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014481:United States; D014493:United States Department of Veterans Affairs
chemical_list: D000998:Antiviral Agents