ABMS Portfolio Program Sponsor Spotlight: University of Utah Health
As one of the newest and smallest clinics of the University of Utah Health system, the South Ogden Health Center wanted to tackle a straightforward, measurable QI project that could have a positive impact in its community.
After considering the 19 quality measures the clinic reviews monthly, the team chose to focus on increasing the number of hepatitis C screenings in community members born between 1945 and 1965, as recommended by the CDC. Adults born within this time frame have an estimated three percent prevalence of hepatitis C virus antibodies, which is six times higher than adults born in other years. The project team set a modest goal of increasing the hepatitis C screening rate in this population from 45.4 percent to 55 percent.
“Given that having hepatitis C can lead to life-threatening health problems like cirrhosis and liver cancer, we felt it was an important target for our QI effort,” said Emily Carlson, MHA, PCMH CCE, LSSGB, the Quality Manager for the Community Physicians Group, University of Utah Health. “While there is no vaccine for hepatitis C, getting tested is important because treatments can cure most people with hepatitis C in just a few months, before they become symptomatic.”
The “Increasing Hepatitis C Screening at South Ogden Health Center” project team brainstormed intervention opportunities to improve hepatitis C screening rates in their clinic. First, the team started with a clean-up of patient data to make sure the appropriate high-risk patients were being targeted. Next, the team reimagined the patient appointment experience to insert natural opportunities to talk with patients about the importance of hepatitis C screenings. All clinic staff members, from the reception desk to the lab techs, were educated on the project, so that the entire team was using shared language when talking with patients and completing paperwork.
The project team included hepatitis C screening on the Pre-Visit Planning sheet to identify patients who need screening. Eye-catching ads and educational materials about hepatitis C and screening were created and placed in the waiting and exam rooms by the patient advisory board and Communications department. The team created magnets to place on the patient’s exam room door to identify when in-room hepatitis C screenings were needed. The team added hepatitis C screening information on the After-Visit Summary that patients receive. Before they left the office, patients were encouraged to schedule follow-ups and get labs drawn onsite. “Hepatitis C Champion” physicians were identified early on in case a patient was diagnosed with the virus and a referral needed to be made. Monthly quality meetings were held by the team to review data and discuss how to remove or work around barriers to patient getting screened.
“Due to the severity of hepatitis C and the ease of the screening test, we thought it would be relatively simple to convince patients to get tested, but we underestimated the cultural barriers we would face,” said Carlson. “We should have talked with more patients to discuss the potential cultural challenges first, to get a realistic picture of the community.”
Located just outside Salt Lake City, the community around the South Ogden Health Center has a significant population of people who are members of The Church of Jesus Christ of Latter-day Saints. Given that this group generally avoids perceived “bad” behaviors that are coincidentally known to spread hepatitis C, such as injection-drug use, getting unregulated tattoos, or having sex with an infected person, they do not feel their risk is high enough to warrant getting screened. To counter this resistance, the project team changed tactics and instead educated patients about how “innocent” activities could expose them to hepatitis C, such as sharing personal items such as razors or toothbrushes or getting a manicure or pedicure with improperly sterilized instruments.
“By teaching patients that a hepatitis C screening is not a judgment of them or their lifestyle, just a part of regular health care, we were able to reach many more people,” said Carlson. “We reassured them that if the test was negative for hepatitis C that was great, but if it was positive, then we have medicine for them and can help them right away.”
Fortunately, the cultural obstacles became easier to deal with, and the results of this project were exceptional. At its baseline, only 45 percent of patients had been screened for hepatitis in March 2019. By May 2021, that number jumped to 75.4 percent, despite the COVID-19 pandemic, when most well visits were cancelled for months. With the changes made in their processes and the community education, the project team expects that number to continue to climb.
Anecdotally, several asymptomatic cases of hepatitis C were found in the community and those patients were immediately referred to and treated by the “Hepatitis C Champion” physicians the team identified.
“The ABMS Portfolio Program has made earning continuing certification more accessible to our providers, which frees them up to take care of their patients, which is our ultimate goal,” said Sahar Pastel-Daneshgar, Maintenance of Certification (MOC) Coordinator for University of Utah Health. “By integrating the QI work providers are already doing into their continuing board certification efforts, it is a win-win-win for the patients, providers, and institution.”
Continuing certification credit for this project was granted by the American Board of Internal Medicine, the American Board of Family Medicine, and the National Commission on Certification of Physician Assistants.
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