Significant improvements in primary care practices across the country as a result of this quality improvement initiative

Summary

Through collaborations with healthcare systems across the United States, Med-IQ has been improving rates of hepatitis C virus (HCV) identification since 2013 using a systems-based quality improvement approach.

Results to date (this initiative is currently in progress):

  • More than 115,900 patient charts reviewed
  • 167 participating clinicians in 25 clinics from 5 healthcare systems
  • More than 9,700 additional HCV tests conducted over a 12-month period, identifying 300 HCV antibody–positive patients

Overview

Built on an existing and proven framework for improving HCV testing rates and linkage to care in the primary care setting, these collaborations leverage existing frameworks, incorporate the patient perspective, and empower a local champion of change at each participating institution. The goal of this initiative is to improve clinician knowledge of which patients should undergo HCV testing by using current clinical evidence and guidelines. In addition, these initiatives are designed to facilitate durable changes in practice that better align processes and recommendations.

Challenge

The disease burden of HCV infection is increasing, driven in part by high prevalence among baby boomers (those born between 1945 and 1965), who account for more than 75% of HCV cases in the United States. Most individuals with HCV infection in this cohort were infected decades ago and do not have ongoing risk behaviors for HCV acquisition. Data suggest that as many as 50% of these people are unaware of their infection.

Recognizing the prevalence of undetected chronic HCV infection, key organizations have released testing guidelines based on birth cohort, even in the absence of ongoing risk factors. These guidelines represent a significant paradigm shift for already overtaxed primary care providers.

Solution

To address this challenge, the collaborating partners and Med-IQ implemented a quality improvement initiative aimed at assessing and improving HCV testing practices. The overall goal is for participating clinicians to demonstrate improved knowledge and competence related to whom, when, and how to test for HCV infection and how to appropriately engage specialty care. Additionally, this initiative is designed to demonstrate that these changes in knowledge and competence can translate into improvements in practice.

The quality improvement initiative consists of:

  • A robust audit/feedback model to evaluate clinical performance, provide data and recommendations to clinicians, and reevaluate the effectiveness of educational interventions
  • A series of brief electronic publications to provide in-depth and sharable resources to support changes in knowledge, competence, and performance
  • A CME-accredited publication
  • Live, onsite CME-accredited workshops
  • Question-and-answer sessions with subject matter experts

Results

This initiative continues to empower clinicians to change clinical practice and improve the likelihood that patients with this silent disease will receive more timely care and potentially avoid irreversible liver dysfunction and/or cancer. Data from the first 3 healthcare systems to complete this initiative demonstrate an average of 530 additional HCV-antibody tests performed every month as a result of these programs.

In just 1 of those healthcare systems, evaluation of testing changes in clinics involved in this quality improvement initiative demonstrated a statistically significant improvement in HCV testing rates compared with clinics not participating in the intervention, despite the development of an electronic health record reminder. These findings were recently published in Health Promotion Practice. Med-IQ and the collaborators were presented with the 2016 Award for Outstanding Educational Collaboration at the Alliance for Continuing Education Health Professions (ACEhp) annual meeting for this work.