Electronic Record Assimilation and Subsequent Eradication of Hepatitis C
Condition: Hepatitis C; Liver Diseases
MeSH terms: Hepatitis A; Hepatitis C; Hepatitis; Liver Diseases
Study type: Interventional

Summary: 
      Given the disproportionately high risk of chronic hepatitis C virus (HCV) infection in the
      baby boomer cohort, population-based screening has been demonstrated cost effective. Compared
      to point-of-care testing, however, bulk health messages with coupled lab requisitions
      delivered directly to patients meeting screening criteria via patient portals could improve
      HCV screening at minimal cost.
    

Detailed description: 
      The Centers for Disease Control and Prevention (CDC) and the United States Preventative
      Services Taskforce (USPSTF) recommend a one-time hepatitis C infection (HCV) screen in
      individuals born 1945-65 (baby boomer birth cohort) and in others with risk factors for
      infection. National adherence to this Grade B recommendation-carrying the same strength of
      evidence as mammography, and screening for depression, alcohol abuse, and type 2 diabetes-is
      estimated to be 13.8%. Efforts to increase screening and linkage to HCV care, and also to
      understand barriers to screening and linkage are therefore warranted.

      One such intervention, direct-to-patient messages via electronic medical record (EMR), has
      been demonstrated to improve adherence in influenza and pneumococcal vaccination, colon
      cancer screening, immunosuppression after transplantation, among others, but has not been
      studied as a strategy to improve HCV screening rates within health systems.

      Our institution, Stanford Health Care, comprises 86 distinct clinical sites with
      approximately 1.25 million outpatient visits per year. All clinical sites are linked with an
      EMR (Epic Systems Corp.) and patients are encouraged to opt-in to receive and send
      health-related messages through a secure internet and smartphone portal, MyHealth.
      Approximately 60% of patients at our institution are enrolled in MyHealth.

      MyHealth additionally allows bulk-messaging of patients meeting specific characteristics,
      e.g. patients due for influenza vaccination. Bulk messages can be coupled with laboratory or
      radiology requisitions. Messages are delivered through the online portal, text message,
      e-mail, and/or smartphone application notification, depending on patient preference.
      Laboratory and radiology results are routed automatically to patients' primary care
      physicians for review.

      The investigators propose to conduct a randomized study comparing the effectiveness of a
      direct-to-patient electronic health message on HCV screening coupled with a lab requisition,
      versus HCV screening initiated by primary care clinicians as part of routine clinical care
      alone.
    

Intervention name(s): Patient portal message
Intervention type(s): Behavioral
Intervention description(s): Direct-to-patient message via the electronic patient portal (MyHealth) with HCV antibody lab order directed to their preferred laboratory
Other intervention name(s): outreach
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Screening
Keywords: Hepatitis C screening; Population Health