1 Ruth M. Rothstein CORE Center, Cook County Health, Chicago, Illinois.
2 Collaborative Research Unit, Cook County Health, Chicago, Illinois.
An estimated 3.5 million Americans are living with the hepatitis C virus (HCV) infection and many are unaware they are infected. Baby boomers (born between 1945 and 1965) account for approximately 75% of people chronically infected with HCV. The Centers for Disease Control and Prevention recommends universal screening of baby boomers. Cook County Health implemented electronic clinical decision support (eCDS) to increase HCV screening among baby boomers. This study evaluated the impact of the eCDS tool on screening and the successive stages of the care continuum by analyzing the proportion of patients who completed (1) anti-HCV screening, (2) HCV ribonucleic acid (RNA) confirmatory testing, (3) HCV RNA detectable result, (4) liver staging, and (5) treatment in the 13-month periods pre and post implementation. As a result, the number of baby boomers tested monthly increased by 344% over the 26-month evaluation period. Of 15,630 patients tested for anti-HCV, 844 (5.4%) tested positive. Patients with anti-HCV positive results were predominantly male (59%), between the ages of 52 and 64 (70%), black/African American (71%), and non-Hispanic (86%). Seventy-two percent of anti-HCV positive patients completed HCV RNA testing; 347 (58%) of those patients had confirmed HCV infection. Of 347 patients with confirmed HCV infection, 198 completed liver staging and 68 initiated treatment. Implementation of eCDS tools across urban safety net health systems is an effective strategy to ensure adherence to national guidelines for HCV screening among baby boomers. The high prevalence of HCV infection in this male, black/African American baby boomer population highlights the urgency of universal screening programs.