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Improving adherence to hepatitis C screening guidelines
  1. Jane Trinh1,2,
  2. Nicholas Turner1,2
  1. 1 Internal Medicine, Duke University Health System, Durham, North Carolina, USA
  2. 2 Pediatrics, Duke University Health System, Durham, North Carolina, USA
  1. Correspondence to Dr Jane Trinh; jane.trinh{at}


Background Hepatitis C (HCV) is a viral liver disease that can result in cirrhosis, hepatocellular carcinoma, liver transplantation or death. The Centers for Disease Control (CDC) estimates that 2.7–3.9 million Americans are living with HCV, yet the majority are unaware. Starting in 2013, both CDC and US Preventative Services Task Force guidelines agreed in recommending HCV screening for all those born between 1945 and 1965 yet many clinics have been slow to adopt screening.

Objective We designed a quality improvement project seeking to improve HCV screening rates among patients seen for new or annual visits to ≥90% over a 3-year period in an academic primary care clinic.

Methods Screening rates were assessed through repeated review of charts (50 per cycle or 300 charts total, roughly 35% of eligible visits) as a series of interventions were executed. Sustainability was assessed by repeating an additional 50-chart analysis 1 year after completion of the study interventions. At the conclusion of the study, a post hoc analysis of socioeconomic factors was undertaken to determine whether gender, income or ethnicity might affect screening rates.

Results Over 6 cycles of interventions, screening rates improved from 24% to ≥90%. Screening rates remained at 88% 1 year after completion of the interventions. The most effective interventions used reminders built into our electronic medical record and informed providers of their personal HCV screening rates relative to the clinic as a whole. Our post hoc analysis found that lower socioeconomic standing and white race were associated with reduced likelihood of screening.

Conclusions Provider adoption of new HCV screening guidelines can be markedly and sustainably increased with electronic medical record prompts as well as directed feedback informing providers of their personal screening rates compared with colleagues.

  • hepatitis C
  • screening
  • quality improvement
  • primary care

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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  • Contributors JT and NT planned the study, and contributed to content of the manuscript. NT conducted the PDSA cycles and data analysis. JT provided data for analysis.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The intent of this work was to improve the quality of care provided to patients in our primary care clinic, and was not a study on patients. As such, the protocol was reviewed by Duke’s Institutional Review Board and granted exempt status.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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