Inga Giske

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The purpose of this quality improvement (QI) project was to increase Hepatitis C Virus (HCV) screening and identification through the implementation of universal screening for HCV with a Medical Assistant (MA) workflow as provider prompt. This QI project evaluated the effectiveness of universal HCV screening in a federally qualified health center (FQHC), community health center (CHC), patient centered medical home serving primarily Medicaid, Medicare and uninsured patients. HCV is a major cause of chronic liver disease throughout the world. It now causes more deaths than any other infectious disease in the United States (US). Costs associated with its treatment are significant and increasing. Therefore, early identification through screening and referral to treatment are essential in preventing the spread of the disease and reducing disease related morbidity and mortality. Methods: Implementation of universal screening for HCV through an MA driven workflow to identify the need for screening and as a provider prompt. Results: The number of HCV at-risk patients screened increased from 1,144 to 1,393, (x2 = 7.96, p = .0048), representing 21.8% increase in the eight weeks post implementation. The screening rate for all clinic patients increased from 27.1% to 32.2% (x2 = 26.598, p < . 00001). Additionally, referrals to HCV treatment increased from 314 to 442 (x2 = 5.507, p = .0189), representing a 40.8% increase. Conclusion: This MA driven universal HCV screening workflow demonstrated the effectiveness of a simple, cost-effective practice change in improving the identification of HCV and referral to treatment.

Author Supplied Keywords

hepatitis C, screening, referral, linkage to care, primary care


Hepatitis C; Medical referral; Medical screening; Medical assistants

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Document Type

Doctoral Project