A new screening protocol developed by Kaiser Permanente can close gaps in the diagnosis and care of hepatitis C virus (HCV) patients, according to recently published research titled “Streamlining Screening to Treatment: The Hepatitis C Cascade of Care at Kaiser Permanente Mid-Atlantic States,” which appeared in the journal Clinical Infectious Diseases.
The study found that the new screening approach could potentially improve disease detection for more than 1.5 million U.S. citizens who are unaware they are chronically infected with HCV.
HCV infection causes the liver to become ill and inflamed. According to the National Health and Nutrition Examination Survey, there are currently 3 to 4 million people in the U.S. who live with this chronic infection. It is estimated that 50 to 80 percent of these people are unaware of their infection, increasing the likelihood of liver damage and the chance they may infect others.
If left untreated, nearly half of those with chronic HCV will develop liver cirrhosis, and 33 percent may die from liver-related complications. Screening is therefore recommended for all patients who are at risk, including people with HIV or patients on kidney dialysis, as well as all those who were born between 1945 and 1965. Despite these efforts, screening gaps are still significant.
“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, M.D., executive director of research at the Mid-Atlantic Permanente Medical Group, in a press release. “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 launched an inclusive HCV screening protocol designed to improve detection and treatment of the disease. The approach included five primary components:
- An automated electronic alert to notify care providers that patients who were born between 1945 and 1965 were recommended for HCV screening;
- Automated confirmatory lab testing for any patient who shows positive results for HCV antibodies, to ensure the patient has a complete diagnosis;
- A hepatitis C care coordinator available to help order follow-up labs, schedule liver damage assessments, and inform patients about the status of their infection;
- Integration of non-invasive, pain-free tests to measure liver damage during the screening;
- Networking and connecting patients to physicians for ongoing care.
A total of 11,200 patients were screened with the new method from October 2014 to July 2015. During this period, the researchers found that:
- Overall, 3.25 percent of patients tested positive for the HCV antibody, and 100 percent of antibody-positive patients received hepatitis C virus RNA testing;
- Of the patients who showed positive results for the hepatitis C virus antibody testing, 75.9 percent had chronic HCV. Of those, 80.8 percent underwent the non-invasive test to measure liver damage;
- Hepatitis C virus diagnosis was communicated to 94 percent of patients.
So far, more than 30,000 mid-Atlantic states patients have been screened for HCV 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,” said M. Cabell Jonas, Ph.D., the study’s lead author and Kaiser Permanente’s senior project manager. “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.”