title: Evaluating a hepatitis c quality gap: missed opportunities for HCV-related cares.
abstract: OBJECTIVE
  Diagnosis of chronic hepatitis C virus (HCV) is a 2-step process involving hepatitis C antibody (HCVab) testing followed by viral ribonucleic acid (RNA) testing. The HCV status of those with a positive HCVab without viral testing cannot be determined. This study sought to describe the HCV-related care provided to patients in this care gap.
  
  
  METHODS
  Retrospective cohort study of active patients with a positive HCVab test who did not complete viral testing.
  
  
  METHODS
  Electronic medical records (EMRs) were reviewed to determine if each subject's first positive HCVab result was acknowledged by a provider. For results acknowledged, we described provider actions in response to the result. When providers performed specific clinical actions within 1 year of the positive HCVab test, we captured the type of action taken. When the unsubstantiated diagnosis was documented in the EMR, we determined if the diagnosis was mentioned by subsequent providers.
  
  
  RESULTS
  Positive HCVab results were not acknowledged in 31% of subjects. In 35%, providers added chronic HCV to the problem list in the EMR, resulting in a higher likelihood of subsequent providers mentioning the diagnosis in their EMR documentation. In 143 subjects whose providers recommended HCV-related clinical actions within 1 year of the positive result, 45% were educated about HCV and 42% had their liver enzymes monitored.
  
  
  CONCLUSIONS
  With more widespread testing anticipated and more effective treatments available, health systems should ensure the HCV diagnostic process results in the delivery of an accurate and timely HCV diagnosis, to reduce the risk of harm to patients.
authors.forename: Yang
authors.initials: Y
authors.lastname: Liu
authors.forename: Renee H
authors.initials: RH
authors.lastname: Lawrence
authors.forename: Yngve
authors.initials: Y
authors.lastname: Falck-Ytter
authors.forename: Brook
authors.initials: B
authors.lastname: Watts
authors.affiliation: HIV/Hepatitis Clinical Pharmacy Specialist, Louis Stokes Cleveland VA Medical Center, Pharmacy Service, 10701 East Blvd, Cleveland, OH 44106. E-mail: amy.hirsch@va.gov.
authors.forename: Amy A
authors.initials: AA
authors.lastname: Hirsch
mesh_terms: D057286:Electronic Health Records; D005260:Female; D016174:Hepacivirus / Q000276:immunology; D018937:Hepatitis C Antibodies / Q000276:immunology; D019698:Hepatitis C, Chronic / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012698:Serologic Tests / Q000706:statistics & numerical data
chemical_list: D018937:Hepatitis C Antibodies