Improving inpatient hepatitis C screening by using EHR default settings

Opportunity

The hepatitis C virus (HCV) is the leading cause of liver transplant and hepatocellular carcinoma in the United States. However, direct-acting antiviral medications are now available and can cure the disease in over 95 percent of those treated.

The Centers for Disease Control and Prevention estimate that 75 percent of all chronic HCV infections are among adults born between 1945 and 1965. In 2016, the Commonwealth of Pennsylvania signed into law that all hospitalized patients born during this period be offered HCV screening.

Alerts in the electronic health record (EHR) have been implemented to prompt screening in the past but have been poorly utilized, with less than 20 percent of eligible patients completing screening.

Approach

We designed a stepped wedge cluster randomized trial to assess if nudges could increase patient hepatitis C screening. We defaulted screening in an admission order set within the EHR and gave clinicians the option to opt-out and not order the screening test.

Impact

The rate of screening ordering nearly doubled, from about 42 percent to about 80 percent, when HCV screening was added to the default admissions order set. Likewise, screening completion rates were much higher – 70 percent, up from 38 percent – with the opt-out intervention.

Collaborators

Penn Medicine Division of Infectious Disease

Funding

Penn Medicine