title: Hepatocellular carcinoma screening practices in the Department of Veterans Affairs: findings from a national facility survey.
abstract: BACKGROUND
  Previous studies suggest low rates of hepatocellular carcinoma (HCC) screening in clinical practice. There is little information on the provider- and healthcare-facility-related factors that explain the use of HCC screening.
  
  
  OBJECTIVE
  We used data from the 2007 Survey to Assess Hepatitis C Care in Veterans Health Administration that collected information regarding the care of patients with hepatitis C virus (HCV) from 138 of 140 Veterans Administration healthcare facilities nationwide.
  
  
  METHODS
  All providers caring for veterans with HCV were invited to respond. In addition, each facility was asked to identify a lead HCV clinician to respond to facility-specific questions. Our outcome was a response concordant with HCC screening guidelines [HCC screening in patients with cirrhosis or in patients with chronic hepatitis B virus (HBV), and screening every 6 or 12 months].
  
  
  RESULTS
  A total of 268 providers responded (98 % facility participation rate). Of these, 190 respondents (70.9 %) reported recommending HCC screening with guideline-concordant risk groups and frequency. Providers reporting guideline-concordant HCC screening practices were significantly more likely to have expertise in liver disease (MD, gastroenterologists or hepatologists), routinely screen for varices, prescribe HCV treatment, and refer or manage patients with liver transplant. The availability of HCC-specific treatments on site was the main facility factor associated with guideline-concordant HCC screening.
  
  
  CONCLUSIONS
  Self-reported rates of guideline-concordant HCC screening are considerably higher than those seen in routine VA practice. Provider expertise in liver disease and the perceived availability of HCC treatment including transplantation in the local facility are important factors driving self-reported HCC screening practices.
authors.affiliation: Houston HSR&D Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd. (152), Houston, TX, 77030, USA, hasheme@bcm.edu.
authors.forename: Hashem B
authors.initials: HB
authors.lastname: El-Serag
authors.forename: Abeer
authors.initials: A
authors.lastname: Alsarraj
authors.forename: Peter
authors.initials: P
authors.lastname: Richardson
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Davila
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Kramer
authors.forename: Janet
authors.initials: J
authors.lastname: Durfee
authors.forename: Fasiha
authors.initials: F
authors.lastname: Kanwal
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D003625:Data Collection; D006526:Hepatitis C / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000458:organization & administration*
chemical_list: D000998:Antiviral Agents