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Opt-Out Framing and Direct Outreach to Increase Hepatitis C Screening Rates

Opt-Out Framing and Direct Outreach to Increase Hepatitis C Screening Rates

Project status

Pilot/study with results


Susan Day, MD, MPH 

Anne Norris, MD 

Colin Wollack 

Pamela Ann Shaw, PhD 

Innovation leads

External partners

Paradigm Digital Color Graphics


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.

Although testing is covered at no cost to patients, HCV screening rates remain low and variable across outpatient practices. 


We investigated whether opt-out framing by way of pre-ordered lab tests, messaging incorporating behavioral science concepts, or electronic communication through the patient portal could increase the uptake of HCV screening among eligible patients. 


Sending eligible patients a screening order along with the usual reminder doubled HCV screening rates, indicating that reducing the effort required by patients and providers can lead to meaningful improvements. The study also found that mailed letters achieved a greater response rate than patient portal messages, signaling that a digital approach might not be best for this older population.

Behavioral science–informed content did not increase uptake, perhaps because it made messages longer.  

Penn Medicine is currently working to establish a centralized outreach department that will employ approaches like this to improve HCV screening uptake and enhance outreach for colorectal and breast cancer screening, A1c screening for patients with diabetes, and more.