A Digital Case-Finding Algorithm for Diagnosed but Untreated Hepatitis C: A Tool for Increasing Linkage to Treatment and Cure.
A Digital Case-Finding Algorithm for Diagnosed but Untreated Hepatitis C: A Tool for Increasing Linkage to Treatment and Cure.
复制标题
DOI：
10.1002/hep.32086
复制
发表时间：
2021-12
期刊：
影响因子：
13.5
通讯作者：
Branch, Andrea D.
中科院分区：
文献类型：
--
作者：
Wyatt, Brooke;Perumalswami, Ponni, V;Mageras, Anna;Miller, Mark;Harty, Alyson;Ma, Ning;Bowman, Chip A.;Collado, Francina;Jeon, Jihae;Paulino, Lismeiry;Dinani, Amreen;Dieterich, Douglas;Li, Li;Vandromme, Maxence;Branch, Andrea D.
尽管慢性丙型肝炎病毒感染增加了死亡率，但仍有数千名患者被诊断但未得到治疗。我们的目标是(1)开发一种DBU表型算法，(2)使用它来促进病例发现和与护理的联系，(3)确定成功治疗的障碍。我们使用Java和SQL开发了一种表型算法，并将其应用于约250万份EPIC电子病历（emr；数据输入于2003年1月至2017年12月）。大约72,000份电子病历包含HCV国际疾病分类代码和/或诊断测试。该算法将10614例病例分类为DBU （HCV‐RNA阳性且存活）。从约72,000份病例中随机抽取500份emr进行人工评价，其阳性预测值为88%，阴性预测值为97%。导航员审查了6187个算法定义的DBUs的图表，并试图通过电话联系潜在的治疗候选者。到2020年6月，30% （n = 1862）的患者完成了与HCV相关的预约。结果分析显示，与其他患者相比，加入我们的护理协调计划的DBU患者更有可能完成治疗（72% [n = 219]对54% [n = 256], P < 0.001），并有验证的持续病毒学反应（67%对46%，P < 0.001）。百分之四十八（n = 2992）的DBU患者无法通过电话联系到，这是参与的主要障碍。这些患者中近一半的纤维化评分≥2.67，表明明显的纤维化。多变量logistic回归显示，无法联系的DBUs比可以联系的DBUs更不可能拥有私人保险（18%比50%；P < 0.001）。数字DBU病例查找算法有效地识别潜在的HCV候选治疗方案，为导航和协调释放资源。该算法是便携式的，当纳入我们的综合方案时，可以加速HCV消除。
Although chronic HCV infection increases mortality, thousands of patients remain diagnosed‐but‐untreated (DBU). We aimed to (1) develop a DBU phenotyping algorithm, (2) use it to facilitate case finding and linkage to care, and (3) identify barriers to successful treatment. We developed a phenotyping algorithm using Java and SQL and applied it to ~2.5 million EPIC electronic medical records (EMRs; data entered January 2003 to December 2017). Approximately 72,000 EMRs contained an HCV International Classification of Diseases code and/or diagnostic test. The algorithm classified 10,614 cases as DBU (HCV‐RNA positive and alive). Its positive and negative predictive values were 88% and 97%, respectively, as determined by manual review of 500 EMRs randomly selected from the ~72,000. Navigators reviewed the charts of 6,187 algorithm‐defined DBUs and they attempted to contact potential treatment candidates by phone. By June 2020, 30% (n = 1,862) had completed an HCV‐related appointment. Outcomes analysis revealed that DBU patients enrolled in our care coordination program were more likely to complete treatment (72% [n = 219] vs. 54% [n = 256]; P < 0.001) and to have a verified sustained virological response (67% vs. 46%; P < 0.001) than other patients. Forty‐eight percent (n = 2,992) of DBU patients could not be reached by phone, which was a major barrier to engagement. Nearly half of these patients had Fibrosis‐4 scores ≥ 2.67, indicating significant fibrosis. Multivariable logistic regression showed that DBUs who could not be contacted were less likely to have private insurance than those who could (18% vs. 50%; P < 0.001). The digital DBU case‐finding algorithm efficiently identified potential HCV treatment candidates, freeing resources for navigation and coordination. The algorithm is portable and accelerated HCV elimination when incorporated in our comprehensive program.
登录
查看更多内容
影响因子：
4.4
作者：
Gaudino, Annette;Gay, Bryn;Graham, Camilla S.
通讯作者：
Graham, Camilla S.
影响因子：
2.3
作者：
Chumbler, Neale R.;Vogel, W. Bruce;Ryan, Patricia
通讯作者：
Ryan, Patricia
影响因子：
12.7
作者：
Laraque, Fabienne;Varma, Jay K.
通讯作者：
Varma, Jay K.
影响因子：
3.7
作者：
Li Y;Chen Y;Zhao Y
通讯作者：
Zhao Y
失访：直接作用治疗级联治疗中的一个重大障碍
影响因子：
2.5
作者：
Darvishian, Maryam;Wong, Stanley;Janjua, Naveed Z.
通讯作者：
Janjua, Naveed Z.