Monique A Foster1, Jian Xing2, Anne C Moorman2, Joseph Boscarino3, Stuart C Gordon4, Mei Lu4, Loralee Rupp4, Mark A Schmidt5, Connie M Trinacty6, Fujie Xu2, Scott D Holmberg2, Philip R Spradling2. 1. Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop G-37, Atlanta, GA, 30329, USA. ydg9@cdc.gov. 2. Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop G-37, Atlanta, GA, 30329, USA. 3. Geisinger Health System, 100 N. Academy Avenue, Danville, PA, 17866, USA. 4. Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI, 48202, USA. 5. Kaiser Permanente Health Research, 3800 N. Interstate Avenue, Portland, OR, 97227, USA. 6. Kaiser Permanente Health Research, 501 Alakawa Street, Suite 201, Honolulu, HI, 96817, USA.
Abstract
BACKGROUND: Linking persons with hepatitis C virus (HCV) to care and treatment is critical to reduction in disease burden; typically, this entailed referral to a specialist. However, data regarding the frequency and factors associated with referral among patients in healthcare organizations (HCOs) are lacking. METHODS: Among persons in four US HCOs with newly diagnosed HCV during 2006-2011, we determined the frequency of liver-related specialist care after diagnosis. We also identified sociodemographic and clinical characteristics associated with such care by multivariate analysis, adjusted for all variables. RESULTS: Among 3592 patients with newly diagnosed HCV, 57 % (range among sites 45-90 %) received specialist care; of these, 57 % received care within 90 days of diagnosis. Patient characteristics associated with receipt of specialist care included: affiliation with one of the study sites [adjusted odds ratio (aOR) 4.8 vs. the referent site); having Medicare plus private insurance (aOR 1.6 vs. Medicaid); and having elevated alanine aminotransferase (ALT) (aOR 1.6 vs. normal ALT) or lower platelet values (aOR 1.4 vs. normal platelet level). Specialist care within 90 days of diagnosis was associated with private insurance (aOR 1.5 vs. Medicaid), elevated ALT levels (aOR 1.3-2.3 vs. normal), and having ≥2 comorbid conditions (aOR 1.4 vs. no comorbid conditions). Compared to patients not referred, those referred were more likely to be treated (aOR 3.5). CONCLUSIONS: Receipt of specialist care among persons with newly diagnosed HCV varied among HCOs. Clinical evidence of liver disease and having private insurance were associated with prompt receipt of specialist care and HCV treatment.
BACKGROUND: Linking persons with hepatitis C virus (HCV) to care and treatment is critical to reduction in disease burden; typically, this entailed referral to a specialist. However, data regarding the frequency and factors associated with referral among patients in healthcare organizations (HCOs) are lacking. METHODS: Among persons in four US HCOs with newly diagnosed HCV during 2006-2011, we determined the frequency of liver-related specialist care after diagnosis. We also identified sociodemographic and clinical characteristics associated with such care by multivariate analysis, adjusted for all variables. RESULTS: Among 3592 patients with newly diagnosed HCV, 57 % (range among sites 45-90 %) received specialist care; of these, 57 % received care within 90 days of diagnosis. Patient characteristics associated with receipt of specialist care included: affiliation with one of the study sites [adjusted odds ratio (aOR) 4.8 vs. the referent site); having Medicare plus private insurance (aOR 1.6 vs. Medicaid); and having elevated alanine aminotransferase (ALT) (aOR 1.6 vs. normal ALT) or lower platelet values (aOR 1.4 vs. normal platelet level). Specialist care within 90 days of diagnosis was associated with private insurance (aOR 1.5 vs. Medicaid), elevated ALT levels (aOR 1.3-2.3 vs. normal), and having ≥2 comorbid conditions (aOR 1.4 vs. no comorbid conditions). Compared to patients not referred, those referred were more likely to be treated (aOR 3.5). CONCLUSIONS: Receipt of specialist care among persons with newly diagnosed HCV varied among HCOs. Clinical evidence of liver disease and having private insurance were associated with prompt receipt of specialist care and HCV treatment.
Authors: Bryce D Smith; Rebecca L Morgan; Geoff A Beckett; Yngve Falck-Ytter; Deborah Holtzman; Chong-Gee Teo; Amy Jewett; Brittney Baack; David B Rein; Nita Patel; Miriam Alter; Anthony Yartel; John W Ward Journal: MMWR Recomm Rep Date: 2012-08-17
Authors: Anne C Moorman; Loralee B Rupp; Stuart C Gordon; Yuna Zhong; Jian Xing; Mei Lu; Joseph A Boscarino; Mark A Schmidt; Yihe G Daida; Eyasu H Teshale; Philip R Spradling; Scott D Holmberg Journal: Infect Dis Clin North Am Date: 2018-06 Impact factor: 5.982
Authors: Philip R Spradling; Yuna Zhong; Anne C Moorman; Loralee B Rupp; Mei Lu; Stuart C Gordon; Eyasu H Teshale; Mark A Schmidt; Yihe G Daida; Joseph A Boscarino Journal: Hepatol Commun Date: 2020-11-29