Opportunity 

Hepatitis C virus (HCV) is a major cause of cirrhosis, liver transplant, and cancer in the United States. Many states, including Pennsylvania, require health systems to offer HCV screening to all hospitalized patients born between 1945 and 1965 due to a higher prevalence of the disease in these birth cohorts.

Despite best practice alerts in the electronic health record (EHR), inpatient HCV screening rates remained low at Penn Medicine at the start of this project.

Intervention 

We implemented a stepped-wedge randomized trial to assess if adding a default order for HCV screening could increase screening order and completion rates.

We embedded the screening order into the default admission order set in the EHR and reframed ordering for HCV screening as opt-out rather than opt-in. An HCV linkage team was also introduced to deliver positive results and facilitate patient treatment and follow-up care. 

Impact 

During the trial, the rate of screening ordering nearly doubled, from about 42 percent to about 80 percent, and screening completion rates rose from 38 percent to 70 percent.

Higher screening rates mean that fewer patients go undiagnosed. And for patients who test positive for HCV, direct-acting antivirals can be introduced to substantially reduce disease burden and contribute to eradication of the virus.

The program has continued at the Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center. Over a two-year period, more than 15,000 people were screened for HCV, and 85 percent of patients with the virus were linked to treatment.

Based on the success of the intervention, Penn Medicine is implementing this approach across all of its hospitals.