Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, 2101 E Jefferson St, 3W, Rockville, MD 20852. Email:
Am J Manag Care. 2018 May 1;24(5):e134-e140.
To evaluate whether the updated 2013 US Preventive Services Task Force (USPSTF) hepatitis C virus (HCV) screening recommendations, related Affordable Care Act provisions, and the impending availability of efficacious therapies were associated with increased screening in an integrated health system.
We analyzed 665,339 records of adult patients visiting Kaiser Permanente Mid-Atlantic States clinics from 2003 to 2014.
We used Cox proportional hazards to estimate time to HCV screening and confirmation after June 1, 2013, compared with prior.
HCV screening steadily increased over time, but it jumped 29% (P <.01) from 2013 to 2014 versus 4% (P <.01) from 2012 to 2013. The adjusted hazard ratio for HCV screening since June 2013 was 2.40 (95% CI, 2.34-2.47) times higher than it was pre-intervention among the birth cohort (those born 1945-1965) and 2.00 (95% CI, 1.96-2.04) times higher in those born in other years, representing a 1.20-fold (95% CI, 1.17-1.24) greater increase in the screening rate among the birth cohort. We also identified variability in those thought to be at higher risk of HCV infection.
HCV screening has been increasing in our healthcare system, more so since June 2013 and among the birth cohort. The availability of efficacious therapies and coverage policies coincident with the USPSTF recommendations may have facilitated access to screening and treatment in ways that were absent at the time of the 2012 CDC recommendations. Health systems must also be poised to make resources available to clinicians and patients in order to incentivize screening. Future research should inform a better understanding of incentives and barriers to screening and linkage to care from all stakeholder perspectives.
评估美国预防服务工作组（USPSTF）2013 年更新的丙型肝炎病毒（HCV）筛查建议、相关平价医疗法案（Affordable Care Act）条款以及即将推出的有效疗法是否与综合医疗系统中筛查的增加有关。
我们分析了 2003 年至 2014 年期间 Kaiser Permanente 中大西洋州诊所的 665339 名成年患者的记录。
我们使用 Cox 比例风险模型估计 2013 年 6 月 1 日之后 HCV 筛查和确认的时间，与之前进行比较。
HCV 筛查率随着时间的推移稳步上升，但与 2012 年至 2013 年的 4%相比，2013 年至 2014 年的筛查率跃升了 29%（P<.01）。自 2013 年 6 月以来，出生队列（1945 年至 1965 年出生的人群）HCV 筛查的调整后危险比是干预前的 2.40（95%CI，2.34-2.47）倍，其他年份出生的人群的危险比是干预前的 2.00（95%CI，1.96-2.04）倍，这代表出生队列的筛查率增加了 1.20 倍（95%CI，1.17-1.24）。我们还发现了 HCV 感染风险较高人群的差异。
在我们的医疗保健系统中，HCV 筛查率一直在增加，自 2013 年 6 月以来以及在出生队列中更是如此。有效的治疗方法和覆盖政策与 USPSTF 建议同时出现，这可能以 2012 年 CDC 建议时所没有的方式促进了筛查和治疗的机会。医疗系统还必须准备好在资源方面为临床医生和患者提供支持，以激励筛查。未来的研究应该从所有利益相关者的角度来告知对筛查和与护理联系的激励措施和障碍的更好理解。
