K. B. Golisch1, J. M. Doll1, J. E. Bannon1, A. E. Van Pelt1, A. Huang1, U. Thakkar1, M. Ghosh1, B. Parker1, J. Boike1, V. S. Rohan1, D. Ladner1 1Northwestern University, Chicago, IL, USA
Introduction:
Adherence to HCC screening guidelines is less than 30%, both nationally and at our health system, despite a 1-8% annual HCC risk for patients with cirrhosis. The Cirrhosis Care Pathway (CCP) was developed as a quality improvement initiative by a multidisciplinary team comprised of physicians, information services, and clinical program leadership to proactively mitigate non-adherence to HCC screening. A pilot study was performed to assess the feasibility of implementing the CCP within a large academic healthcare system.
Methods:
During the 3-month pilot period (04/23-07/23), CCP followed a four-step process (Figure 1). Adult (≥18 years) patients with cirrhosis who had an encounter 01/19-04/23, known PCP, and overdue HCC screening (>6 months) were extracted from EHR using validated cirrhosis ICD/CPT codes. Patients with HCC diagnosis, terminal illness, or actively followed by hepatology were excluded. A Nurse Navigator (NN) and MD performed initial chart audits to confirm eligibility. An EHR message was sent to the PCP of eligible patients: (1) providing date of upcoming appointment, reminder of need for HCC screening, provision of EMR list of qualifying imaging options and (2) permission was asked to contact the patient directly. Permitted patients were messaged by NN with educational HCC materials and offered scheduling support. PCP and patient response to NN and HCC screening status were documented on a pathway tracker.
Results:
271 patients were identified based on ICD/CPT codes and 130 were excluded after MD/NN review. 141 PCP messages were sent, 85 replies (60%) were received. Based on PCP responses, 41 patients excluded. 100 were eligible for inclusion. Age (mean) was 66 years and 54% were female. 65 HCC screenings were ordered (65%), 32 were scheduled (32%), and 30 were completed (30%). PCP messaged that screening was ordered for 39 patients (39%) and permission to contact the patient directly was granted for 26 patients (26%). No new HCC was identified. 26 permitted patients (100%) were contacted directly by NN, all received educational materials and were offered scheduling help. Of those 17 HCC screenings (65%) were ordered and 7 HCC screenings (29%) were scheduled and completed. 2 patients (8%) requested help with scheduling.
Conclusion:
One EHR message to PCPs for HCC surveillance screening resulted in 65% of eligible patients receiving an order for HCC screening and 32% receiving screening in a 3-month pilot. Direct NN/patient communication did not result in higher screening or significant need for support. Our findings demonstrate feasibility of a Clinical Care Pathway with immediate increase in HCC screening. Next steps will include repeat PCP reminders to the PCPs and expanding the test cohort.
