Nitsche Bruce, Miller Sara C, Giorgio Margaret, Berry Carolyn A, Muir Andrew
1 Virginia Mason, Seattle, WA, USA.
2 Med-IQ, LLC, Baltimore, MD, USA.
Health Promot Pract. 2018 Jul;19(4):506-512. doi: 10.1177/1524839917725501. Epub 2017 Sep 11.
An estimated 3 to 5 million Americans are chronically infected with hepatitis C virus (HCV), and approximately 75% of those persons were born between 1945 and 1965 (the so-called baby boomer generation). Because of the largely asymptomatic nature of HCV, up to 50% of those infected are unaware of their disease. Risk-based testing has been largely ineffective. Based on prevalence data, the Centers for Disease Control and Prevention and other organizations recommend a onetime HCV antibody test for all baby boomers. However, uptake of this recommendation requires significant changes in clinical practice for already busy primary care clinicians. We studied the effectiveness of a quality improvement initiative based on continuous audit and feedback combined with education for improving testing in alignment with guidelines; the control group was a cohort of clinicians whose only reminder was an institution-wide electronic health record prompt. Our data show improved testing rates among all clinician groups, but more significant improvement occurred among providers who received continuous feedback about their clinical performance coupled with education.
据估计，有300万至500万美国人长期感染丙型肝炎病毒（HCV），其中约75%出生于1945年至1965年之间（即所谓的婴儿潮一代）。由于HCV感染在很大程度上没有症状，高达50%的感染者并不知道自己患病。基于风险的检测在很大程度上效果不佳。根据患病率数据，疾病控制与预防中心及其他组织建议对所有婴儿潮一代进行一次HCV抗体检测。然而，要落实这一建议，对于本就忙碌的基层医疗临床医生而言，临床实践需要做出重大改变。我们研究了一项质量改进举措的效果，该举措基于持续审核与反馈并结合教育，以促使检测符合指南要求；对照组是一组临床医生，他们唯一收到的提醒是全机构范围的电子健康记录提示。我们的数据显示，所有临床医生组的检测率都有所提高，但在那些收到关于其临床绩效的持续反馈并接受教育的医疗服务提供者中，改善更为显著。
