title: Streamlining Screening to Treatment: The Hepatitis C Cascade of Care at Kaiser Permanente Mid-Atlantic States.
abstract: Hepatitis C virus (HCV) screening is recommended for patients at risk and/or born during 1945-1965, but screening gaps persist. This new program screens target populations and enhances care linkage for chronically HCV-infected patients. Kaiser Permanente Mid-Atlantic States created a comprehensive HCV screening pathway, supported by a HCV care coordinator. The testing pathway includes HCV antibody (Ab), automatic HCV RNA for Ab-positive patients, coinfection and liver health tests, vibration-controlled transient elastography (VCTE), and a physician referral. A total of 11 200 patients were screened; 3.25% were HCV Ab positive, and 100% of Ab-positive patients received HCV RNA testing. Of HCV Ab-positive patients, 75.9% had chronic HCV, of which 80.8% underwent VCTE. HCV diagnosis was communicated to 94% of patients, and 70.9% had HCV documented in the electronic health record. The pathway shows promise in closing gaps, including improving HCV RNA testing, communicating diagnoses, and assessing liver fibrosis. Improved testing and linkage could increase curative treatment access.
authors.affiliation: Mid-Atlantic Permanente MedicalGroup.
authors.forename: M Cabell
authors.initials: MC
authors.lastname: Jonas
authors.affiliation: Mid-Atlantic Permanente Research Institute.
authors.forename: Carla V
authors.initials: CV
authors.lastname: Rodriguez
authors.affiliation: Gastroenterology Department, Mid-Atlantic Permanente Medical Group, Rockville, Maryland.
authors.forename: Jacquelyn
authors.initials: J
authors.lastname: Redd
authors.affiliation: Gastroenterology Department, Mid-Atlantic Permanente Medical Group, Rockville, Maryland.
authors.forename: Dana A
authors.initials: DA
authors.lastname: Sloane
authors.affiliation: Gastroenterology Department, Mid-Atlantic Permanente Medical Group, Rockville, Maryland.
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Winston
authors.affiliation: Mid-Atlantic Permanente Medical Group.|Permanente Medical Group, Oakland, California.
authors.forename: Bernadette C
authors.initials: BC
authors.lastname: Loftus
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D016174:Hepacivirus / Q000235:genetics* / Q000276:immunology*; D006526:Hepatitis C / Q000175:diagnosis* / Q000276:immunology / Q000821:virology; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008873:Mid-Atlantic Region; D008875:Middle Aged
chemical_list: D018937:Hepatitis C Antibodies
keywords: HCV; cascade of care; hepatitis C virus; linkage to care; screening