Evaluation of a hepatitis C clinical care coordination programme's effect on treatment initiation and cure: A surveillance-based propensity score matching approach
Evaluation of a hepatitis C clinical care coordination programme's effect on treatment initiation and cure: A surveillance-based propensity score matching approach
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DOI：
10.1111/jvh.12929
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发表时间：
2018-11-01
影响因子：
2.5
通讯作者：
Laraque, F.
中科院分区：
文献类型：
--
作者：
Deming, R.;Ford, M. M.;Laraque, F.
丙型肝炎是一种病毒感染，如果不治疗，可能会严重损害肝脏。INSPIRE项目是纽约市(NYC)为期3年的丙型肝炎病毒护理协调方案，旨在通过向患者提供支持性服务和健康促进来解决治疗开始和治愈的障碍。我们研究了参加INSPIRE项目与没有参加该项目的人口统计学上相似的人群相比，是否与丙型肝炎治疗和治愈方面的差异有关。将2015年的INSPIRE参与者与纽约市监测登记中确定的一组丙型肝炎病毒感染者进行匹配，使用完全最佳的倾向分数匹配，并按INSPIRE注册状态进行分层。条件Logistic回归用于评估两种治疗结果的组间差异。还进行了两次后续敏感性分析，分别使用单独的配对集合和完整的未调整队列。72%的INSPIRE参与者和36%(11960/32819)的符合研究条件的对照组开始了治疗。在发起者中，65%(514/790)的INSPIRE参与者治愈，而对照组的47%(5641/11960)治愈。在配对分析中，加入INSPIRE增加了开始治疗(OR：5.25，95%CI：4.47-6.17)和治愈(OR：2.52，95%CI：2.00-3.16)的几率。灵敏度分析的结果与完全最优匹配的结果一致。参与丙型肝炎病毒护理协调计划大大增加了治疗开始和治愈的可能性，表明对丙型肝炎病毒感染者的护理协调改善了治疗结果。
Hepatitis C (HCV) is a viral infection that if left untreated can severely damage the liver. Project INSPIRE was a 3year HCV care coordination programme in New York City (NYC) that aimed to address barriers to treatment initiation and cure by providing patients with supportive services and health promotion. We examined whether enrolment in Project INSPIRE was associated with differences in HCV treatment and cure compared with a demographically similar group not enrolled in the programme. INSPIRE participants in 2015 were matched with a cohort of HCV-infected persons identified in the NYC surveillance registry, using full optimal matching on propensity scores and stratified by INSPIRE enrolment status. Conditional logistic regression was used to assess group differences in the two treatment outcomes. Two follow-up sensitivity analyses using individual pair-matched sets and the full unadjusted cohort were also conducted. Treatment was initiated by 72% (790/1130) of INSPIRE participants and 36% (11960/32819) of study-eligible controls. Among initiators, 65% (514/790) of INSPIRE participants compared with 47% (5641/11960) of controls achieved cure. In the matched analysis, enrolment in INSPIRE increased the odds of treatment initiation (OR: 5.25, 95% CI: 4.47-6.17) and cure (OR: 2.52, 95% CI: 2.00-3.16). Results from the sensitivity analyses showed agreement with the results from the full optimal match. Participation in the HCV care coordination programme significantly increased the probability of treatment initiation and cure, demonstrating that care coordination for HCV-infected individuals improves treatment outcomes.