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Association Between Facility Characteristics and the Process of Care Delivered to Patients with Hepatitis C Virus Infection

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Abstract

Background

Available data suggest problems in the process of care provided to patients with chronic hepatitis C (HCV). However, the solutions to these problems are less obvious. Healthcare facility factors are potentially modifiable and may enhance process quality in HCV treatment.

Methods

We evaluated the relationship between the process of HCV care and facility factors including number of weekly half-day HCV clinics per 1,000 HCV patients, HCV-specific quality-improvement initiatives, and administrative service of the HCV clinic (gastroenterology, infectious disease, primary care) for a cohort of 34,258 patients who sought care in 126 Veterans Affairs facilities during 2003–2006. We measured HCV care on the basis of 23 HCV-specific process measures capturing pretreatment (seven measures), preventive and/or comorbid (seven measures), and treatment and treatment monitoring care (nine measures).

Results

Patients seen at a facility with >8 half-day clinics were 52 % more likely to receive overall indicated care (OR 1.52, 95 % CI 1.13–2.05). Patients seen at a facility with >3 HCV quality improvement initiatives were more likely to receive better preventive and/or comorbid care (OR 1.32, 95 % CI 1.00–1.74). Compared with patients in facilities with no dedicated HCV clinic, patients at facilities with gastroenterology-based clinics received better pretreatment care (OR 1.36, 95 % CI 1.01–1.85) and more antiviral treatment (OR 1.45, 95 % CI 1.06–1.97) whereas those at facilities with infectious disease-based or primary care-based clinics received better preventive and/or comorbid care (OR 1.59, 95 % CI 1.06–2.39 and 1.84, 95 % CI 1.21–2.79 respectively).

Conclusion

Several facility factors affected the process of HCV care. These factors may serve as targets for quality-improvement efforts.

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References

  1. Armstrong GL, Wasley A, Simard EP, McQuillan GM, Kuhnert WL, Alter MJ. The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Ann Intern Med. 2006;144:705–714.

    Article  PubMed  Google Scholar 

  2. Kim WR, Brown RS Jr, Terrault NA, El-Serag H. Burden of liver disease in the United States: summary of a workshop. Hepatology. 2002;36:227–242.

    Article  PubMed  Google Scholar 

  3. Ghany MG, Strader DB, Thomas DL, Seeff LB. American Association for the Study of Liver Diseases. Diagnosis, management, and treatment of hepatitis C: an update. Hepatology. 2009;49:1335–1374.

    Article  CAS  PubMed  Google Scholar 

  4. Seeff LB, Hoofnagle JH. National Institutes of Health Consensus Development Conference: management of hepatitis C: 2002. Hepatology. 2002;36:S1–S2.

    Article  PubMed  Google Scholar 

  5. Kanwal F, Schnitzler MS, Bacon BR, Hoang T, Buchanan PM, Asch SM. Quality of care in patients with chronic hepatitis C virus infection: a cohort study. Ann Intern Med. 2010;153:231–239.

    Article  PubMed  Google Scholar 

  6. Kramer JR, Hachem CY, Kanwal F, Mei M, El-Serag HB. Meeting vaccination quality measures for hepatitis A and B virus in patients with chronic hepatitis C infection. Hepatology. 2011;53:42–52.

    Article  PubMed  Google Scholar 

  7. Butt AA, Justice AC, Skanderson M, Rigsby MO, Good CB, Kwoh CK. Rate and predictors of treatment prescription for hepatitis C. Gut. 2007;56:385–389.

    Article  PubMed  Google Scholar 

  8. Medicare Quality Measurement and Reporting Programs. Available at: http://www.healthreformgps.org/resources/medicare-quality-measurement-and-reporting-programs/. Accessed June 2012.

  9. Backus LI, Boothroyd DB, Phillips BR, Mole LA. Pretreatment assessment and predictors of hepatitis C virus treatment in US veterans coinfected with HIV and hepatitis C virus. J Viral Hepat. 2006;13:799–810.

    Article  CAS  PubMed  Google Scholar 

  10. Bini EJ, Brau N, Currie S, et al. Prospective multicenter study of eligibility for antiviral therapy among 4,084 U.S. veterans with chronic hepatitis C virus infection. Am J Gastroenterol. 2005;100:1772–1779.

    Article  PubMed  Google Scholar 

  11. Witkos M, Yi QL, Heathcote J, Kapral MK, Krahn MD. Predictors of antiviral therapy in a post-transfusion cohort of hepatitis C patients. Can J Gastroenterol. 2006;20:107–111.

    PubMed Central  PubMed  Google Scholar 

  12. Kanwal F, Hoang T, Spiegel BM, et al. Predictors of treatment in patients with chronic hepatitis C infection—role of patient versus nonpatient factors. Hepatology. 2007;46:1741–1749.

    Article  CAS  PubMed  Google Scholar 

  13. Kim C, Hofer TP, Kerr EA. Review of evidence and explanations for suboptimal screening and treatment of dyslipidemia in women: a conceptual model. J Gen Intern Med. 2003;18:854–863.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Ashton CM, Petersen NJ, Souchek J, et al. Geographic variations in utilization rates in Veterans Affairs hospitals and clinics. N Engl J Med. 1999;340:32–39.

    Article  CAS  PubMed  Google Scholar 

  15. McGinn J, Davis C. Geographic variation, physician characteristics, and diabetes care disparities in a metropolitan area, 2003–2004. Diabetes Res Clin Pract. 2006;72:162–169.

    Article  PubMed  Google Scholar 

  16. McPherson K, Wennberg JE, Hovind OB, Clifford P. Small-area variations in the use of common surgical procedures: an international comparison of New England, England, and Norway. N Engl J Med. 1982;307:1310–1314.

    Article  CAS  PubMed  Google Scholar 

  17. O’Connor GT, Quinton HB, Traven ND, et al. Geographic variation in the treatment of acute myocardial infarction: the Cooperative Cardiovascular Project. JAMA. 1999;281:627–633.

    Article  PubMed  Google Scholar 

  18. Welch WP, Miller ME, Welch HG, Fisher ES, Wennberg JE. Geographic variation in expenditures for physicians’ services in the United States. N Engl J Med. 1993;328:621–627.

    Article  CAS  PubMed  Google Scholar 

  19. Wennberg DE, Lucas FL, Birkmeyer JD, Bredenberg CE, Fisher ES. Variation in carotid endarterectomy mortality in the Medicare population: trial hospitals, volume, and patient characteristics. JAMA. 1998;279:1278–1281.

    Article  CAS  PubMed  Google Scholar 

  20. Backus LI, Gavrilov S, Loomis TP, et al. Clinical Case Registries: simultaneous local and national disease registries for population quality management. J Am Med Inform Assoc. 2009;16:775–783.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Yano EM: VA Clinical Practice Organizational Survey: Chief of Staff Module. Book VA Clinical Practice Organizational Survey: Chief of Staff Module City: VA HSR&D Center of Excellence for the Study of Healthcare Provider Behavior; 2006.

  22. Kanwal F, Hoang T, Kramer J, et al. The performance of process measures in hepatitis C. Am J Gastroenterol. 2012;107(10):1512-1521.

    Google Scholar 

  23. Clinical Classifications Software (CCS) for ICD-9-CM. Available at http://www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp. Accessed June 2012.

  24. SAS statistical program, version 9.1 (SAS Inc., Cary, NC), 2012.

  25. Sochalski J. Is more better? The relationship between nurse staffing and the quality of nursing care in hospitals. Med Care. 2004;42:II67–II73.

    Article  PubMed  Google Scholar 

  26. Managing chronic disease in Ontario Primary Care. The impact of organizational factors. Ann Fam Med. 2009;7:309–318.

    Article  Google Scholar 

  27. Jacobson IM, McHutchison JG, Dusheiko G, et al. ADVANCE Study Team. Telaprevir for previously untreated chronic hepatitis C virus infection. N Engl J Med. 2011;364:2405–2416.

    Article  CAS  PubMed  Google Scholar 

  28. Poordad F, McCone J Jr, Bacon BR, et al. SPRINT-2 Investigators. Boceprevir for untreated chronic HCV genotype 1 infection. N Engl J Med. 2011;364(13):1195–1206.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

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Acknowledgments

This material is based on work supported, in part, by the Health Services Research and Development Service, the Office of Research and Development, the Department of Veterans Affairs grant IIR-07-111 to Dr Kanwal. The authors are indebted to the Veterans Health Administration Hepatitis C Clinical Case Registry, Clinical Public Health, and Healthcare Analysis and Information Group for the data used in this study. Dr. Yano’s time was covered by a VA HSR&D Senior Research Career Scientist Award (Project #05-195). VA organizational data were obtained from VA HSR&D-funded studies (Projects #06-087 and #09-082).

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Houston VA HSR&D Center of Excellence, Health Services Research and Development Service, Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd, Houston, TX, 77030, USA

    Fasiha Kanwal, Jennifer R. Kramer & Hashem B. El-Serag

  2. Section of Gastroenterology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA

    Fasiha Kanwal & Hashem B. El-Serag

  3. Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA

    Tuyen Hoang & Elizabeth M. Yano

  4. John Cochran VA Medical Center, St. Louis, MO, USA

    Timothy Chrusciel

  5. Office of Public Health/Clinical Public Health, Washington, DC, USA

    Janet Durfee

  6. VA Puget Health Care System, Seattle, WA, USA

    Jason A. Dominitz

  7. VA Greater Los Angeles HSR&D Center of Excellence, Sepulveda, CA, USA

    Elizabeth M. Yano

  8. Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA

    Elizabeth M. Yano

  9. VA HSR&D Center of Excellence, Health Services Research and Development Service, VA Palo Alto, Palo Alto, CA, USA

    Steven M. Asch

  10. Department of Medicine, Stanford University College of Medicine, Palo Alto, CA, USA

    Steven M. Asch

Authors
  1. Fasiha Kanwal
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  2. Tuyen Hoang
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  3. Timothy Chrusciel
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  4. Jennifer R. Kramer
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  5. Hashem B. El-Serag
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  6. Janet Durfee
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  7. Jason A. Dominitz
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  8. Elizabeth M. Yano
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  9. Steven M. Asch
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Corresponding author

Correspondence to Fasiha Kanwal.

Additional information

Disclaimer: The opinions and assertions contained herein are solely the views of the authors and are not to be construed as official or as reflecting the views of the Department of Veteran Affairs.

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Kanwal, F., Hoang, T., Chrusciel, T. et al. Association Between Facility Characteristics and the Process of Care Delivered to Patients with Hepatitis C Virus Infection. Dig Dis Sci 59, 273–281 (2014). https://doi.org/10.1007/s10620-013-2773-z

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  • DOI: https://doi.org/10.1007/s10620-013-2773-z

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