Behavioral Science and Hepatitis C Screening Outreach
Condition: Hepatitis C
MeSH terms: Hepatitis A; Hepatitis C; Hepatitis
Study type: Interventional

Summary: 
      This project aims to evaluate different approaches to increase Hepatitis C screening among
      primary care patients at Penn Medicine through a centralized screening outreach program. In a
      pragmatic trial, we will evaluate different approaches to increase completion of screening
      among eligible patients, including changing the default from opt-in to opt-out and
      incorporating behavioral science principles into the outreach communication.
    

Detailed description: 
      The hepatitis C virus (HCV) is the leading cause of liver transplant and hepatocellular
      carcinoma in the US. New direct-acting antivirals are available that can eradicate the
      disease in over 95% of those that are treated, with minimal side effects. As a result of new
      therapies and a five-fold higher risk among baby boomers, the US Preventive Services Task
      Force and CDC now recommend HCV screening for all patients born between 1945 and 1965. Of the
      estimated 3.2 million people chronically infected with HCV, about 75% were born during this
      time frame. Despite this, national rates of screening among this group remain low at less
      than 30%. If more people could get screened, we could potentially identify more undiagnosed
      disease and help navigate to treatment.

      At Penn Medicine primary care practices, HCV screening rates have risen from 37% in 2014 to
      61% in 2017, likely from a combination of provider educational efforts and EHR alerts. There
      is also significant practice variation ranging from 4% to 99% screening rates. While EHR
      alerts have been shown to increase HCV screening rates, there is potential to complement this
      with direct outreach to patients homes, as has been incorporated into cancer screening
      initiatives. Additionally, there is a mandate from the state of Pennsylvania requiring health
      care providers to offer HCV testing to all primary care patients. There is an opportunity to
      provide direct outreach to all eligible primary care patients at Penn Medicine, while also
      evaluating different approaches to increasing HCV screening rates.

      Insights from behavioral science have been shown to increase participation in health
      promoting behaviors in a variety of ways. Switching from opt-in to opt-out framing has been
      shown to triple patient participation in remote monitoring and CRC screening. Additionally,
      messaging that incorporates social norms, reciprocity, and precommitment have also been shown
      to increase participation. However, it is not clear how these approaches would translate to
      HCV screening.
    

Intervention name(s): Opt-Out; Letter; Behavioral Economic Messaging; Usual Care Messaging
Intervention type(s): Behavioral; Behavioral; Behavioral; Behavioral
Intervention description(s): Opt-In messaging prompts participants to contact their primary care provider to receive Hepatitis C screening whereas Opt-Out messaging includes a signed laboratory order for Hepatitis C screening.; Participants receive messaging prompting them to contact their primary care provider to receive Hepatitis C screening, either as a letter or an electronic message on the MyPennMedicine patient portal.; Participants receive standard messaging about HCV and ways to get screened and messaging that incorporates behavioral economic principles such as norms, reciprocity, anticipated regret, and pre-commitment to get screening.; Participants receive standard messaging about HCV and ways to get screening.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Screening
Keywords: Behavioral Economics; Screening; Outreach