An Electronic Health Record-based Intervention to Promote Hepatitis C Virus Testing Among Adults Born Between 1945 and 1965: A Cluster-randomized Trial

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To the Editor:
The paper by Federman and colleagues in the June 2017 issue of Medical Care offers useful insights from a cluster-randomized trial on the value of a best practice alert in improving hepatitis C virus (HCV) screening of persons born from 1945 to 1965 (baby boomers).1 However, in the discussion, authors erroneously stated that our study of an automatic order for HCV screening with an opt-out option resulted testing 49% of eligible baby boomers admitted for any reason to a safety net hospital. In fact, 41% of admitted patients were ineligible because of prior HCV testing or diagnosis.2 In 2015, we published a more complete report from that inpatient screening program.3 Among 9037 hospitalized baby boomers, we excluded 993 (10.9%) because of an HCV diagnosis and 2957 (32.7%) with a prior HCV test in the electronic medical record. Among all 5087 eligible baby boomers, 4,582 (90%) were tested for anti-HCV antibody and 316 (6.9%) were positive. Among these, 287 (90.8%) received a reflex test for HCV RNA and 175 (3.8% of all screened patients) were diagnosed with chronic HCV infection. As only patients with chronic HCV infection need to receive care for HCV, it is a limitation of the otherwise strong Federman study that RNA testing rates and results were not reported. We believe that our inpatient screening program offers a valuable model for other hospitals serving low-income populations.

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