Implementation Overview

Background

The U.S. Preventive Services Task Force has issued a Grade B recommendation for universal, one-time HCV screening of baby boomers and to evaluate and treat those with chronic HCV infection. Implementation of this guideline can significantly reduce HCV-related mortality. To date, the most successful programs have typically been in practices serving well-insured patients and supported by high-functioning electronic medical records (EMR). Given that low-income, underinsured, minority populations bear the greatest burden of HCV infection in the U.S., our tools and strategies have been especially developed for practices serving these vulnerable populations.

 

Targeting underserved and vulnerable populations

Key barriers for practices serving vulnerable populations to HCV screening and management include:

  • Poorly functioning EMR
  • Limited staff support with overburdened clinicians
  • Limited local access to specialist care
  • Uninsured patients
  • Social and economic barriers for patient care
  • Social stigma
  • Lack of culturally competent resources for engaging patients in healthcare decision making.

 

Key program components

After more than seven years of implementing screening programs within clinics across South Texas and the Dallas area, we have distilled what we believe are critical program components:

  • Clinician and Staff Education on HCV epidemiology, screening, management, and treatment
  • Patient education on HCV screening, transmission, risks, and treatment
  • Redesign of the electronic medical record (EMR) to support screening, confirmatory testing, and clinical management
  • Protocols for efficient laboratory testing throughout testing and treatment
  • Performance monitoring through the EMR to support rapid-cycle quality improvement and patient navigation
  • Individualized navigation for patients from diagnosis to cure
  • Staff support with an onsite clinical champion and on- or off-site patient navigator
  • Clinical infrastructure for efficient linkage to free treatment through pharmaceutical assistance programs (PAPs)
  • Access to specialist (tele)consultation to support the provider in delivering onsite care for patients with HCV