Hepatitis C
Conditions
Keywords
Hepatitis C, HCV screening, nudge, defaults
Brief summary
This study will use a stepped-wedge cluster randomized clinical trial to evaluate a health system initiative to set defaults in the electronic health record admission order set to nudge inpatient hepatitis C (HCV) screening.
Detailed description
The hepatitis C virus (HCV) is the leading cause of liver transplant and hepatocellular carcinoma in the United States, but direct-acting antiviral medications are now available and can cure the disease in over 95% of those that are treated. The Centers for Disease Control and Prevention (CDC) estimate that 75% of all chronic HCV infections in the United States are among adults born between 1945 and 1965. The CDC and US Preventive Services Task Force (USPTF) therefore recommends birth cohort screening for all adults born in this time period. In 2016, the Commonwealth of Pennsylvania signed into law a requirement that all hospitalized patients born during this time period be offered HCV screening. In this study, a stepped-wedge cluster randomized clinical trial will be conducted to test the effect of defaulting HCV screening into the admission order set to improve screening rates.
Interventions
BEHAVIORALNudge
Clinicians will receive a default order upon entering the the admission order set. They will have the opportunity to opt-out and not order screening. Clinicians will receive the nudge each time they enter the admission order set for a new, eligible patient.
Sponsors
University of Pennsylvania
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
DOUBLE (Investigator, Outcomes Assessor)
Masking description
The principal study investigator and data analyst will not have knowledge of when the hospital sites are randomized to the intervention.
Intervention model description
Hospital sites will be cluster randomized to the intervention in 3 month blocks over 6 months, after which both sites will receive the default intervention.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Be admitted to the Hospital of the University of Pennsylvania (HUP) or Penn Presbyterian Medical Center (PPMC) * Born between 1945 and 1965
Exclusion criteria
* Patients will be excluded if they have already received Hepatitis C screening or have been previously diagnosed with Hepatitis C.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in percentage of eligible patients that receive HCV antibody screening | 6 months | The change in the percentage of eligible hospitalized patients that receive HCV antibody screening |
Other
| Measure | Time frame | Description |
|---|---|---|
| Percentage of patients that are HCV antibody positive | 9 months | The percentage of eligible hospitalized patients that are HCV antibody positive |
| Percentage of patients that have positive HCV testing who receive either linkage to care and/or treatment | 9 months | The percentage of eligible hospitalized patients that have positive HCV testing who receive either linkage to care and/or treatment |
| Change in the percentage of eligible patients that are viral load positive for HCV | 9 months | The change in the percentage of eligible hospitalized patients that are viral load positive for HCV |
Countries
United States
Outcome results
None listed