Original Article

Digestive Diseases and Sciences

, Volume 58, Issue 11, pp 3117-3126

First online:

Hepatocellular Carcinoma Screening Practices in the Department of Veterans Affairs: Findings from a National Facility Survey

  • Hashem B. El-SeragAffiliated withHouston HSR&D Center of Excellence, Michael E. DeBakey Veterans Affairs Medical CenterSection of Gastroenterology and Hepatology, Michael E. DeBakey VA Medical CenterDepartment of Medicine, Baylor College of Medicine Email author 
  • , Abeer AlsarrajAffiliated withHouston HSR&D Center of Excellence, Michael E. DeBakey Veterans Affairs Medical CenterSection of Health Services Research, Michael E. DeBakey VA Medical CenterDepartment of Medicine, Baylor College of Medicine
  • , Peter RichardsonAffiliated withHouston HSR&D Center of Excellence, Michael E. DeBakey Veterans Affairs Medical CenterSection of Health Services Research, Michael E. DeBakey VA Medical CenterDepartment of Medicine, Baylor College of Medicine
  • , Jessica A. DavilaAffiliated withHouston HSR&D Center of Excellence, Michael E. DeBakey Veterans Affairs Medical CenterSection of Health Services Research, Michael E. DeBakey VA Medical CenterDepartment of Medicine, Baylor College of Medicine
  • , Jennifer R. KramerAffiliated withHouston HSR&D Center of Excellence, Michael E. DeBakey Veterans Affairs Medical CenterSection of Health Services Research, Michael E. DeBakey VA Medical CenterDepartment of Medicine, Baylor College of Medicine
  • , Janet DurfeeAffiliated withDepartment of Veterans Affairs, Office of Public Health
  • , Fasiha KanwalAffiliated withHouston HSR&D Center of Excellence, Michael E. DeBakey Veterans Affairs Medical CenterSection of Gastroenterology and Hepatology, Michael E. DeBakey VA Medical CenterDepartment of Medicine, Baylor College of Medicine

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Abstract

Background

Previous studies suggest low rates of hepatocellular carcinoma (HCC) screening in clinical practice. There is little information on the provider- and healthcare-facility-related factors that explain the use of HCC screening.

Aims

We used data from the 2007 Survey to Assess Hepatitis C Care in Veterans Health Administration that collected information regarding the care of patients with hepatitis C virus (HCV) from 138 of 140 Veterans Administration healthcare facilities nationwide.

Methods

All providers caring for veterans with HCV were invited to respond. In addition, each facility was asked to identify a lead HCV clinician to respond to facility-specific questions. Our outcome was a response concordant with HCC screening guidelines [HCC screening in patients with cirrhosis or in patients with chronic hepatitis B virus (HBV), and screening every 6 or 12 months].

Results

A total of 268 providers responded (98 % facility participation rate). Of these, 190 respondents (70.9 %) reported recommending HCC screening with guideline-concordant risk groups and frequency. Providers reporting guideline-concordant HCC screening practices were significantly more likely to have expertise in liver disease (MD, gastroenterologists or hepatologists), routinely screen for varices, prescribe HCV treatment, and refer or manage patients with liver transplant. The availability of HCC-specific treatments on site was the main facility factor associated with guideline-concordant HCC screening.

Conclusions

Self-reported rates of guideline-concordant HCC screening are considerably higher than those seen in routine VA practice. Provider expertise in liver disease and the perceived availability of HCC treatment including transplantation in the local facility are important factors driving self-reported HCC screening practices.

Keywords

Viral hepatitis Epidemiology Hepatoma Liver cancer