studies

HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 481A
both tests, the correct answer was chosen 79% of the time after
the rotation. Conclusion: Our novel curriculum for a non-elective
consult rotation has effectively demonstrated improvement in IM
residents’ comfort with and knowledge of CLD. A trend towards
increased career interest in hepatology was also observed,
which suggests more exposure to CLD could positively impact
recruitment to the workforce.
Disclosures:
Donald M. Jensen - Advisory Committees or Review Panels: Merck, Onom Foundation;
Speaking and Teaching: Gilead
K. Gautham Reddy - Advisory Committees or Review Panels: AASLD Transplant
Hepatology Pilot Steering Committee, ACG Training Committee, Program Director’s
Caucus Steering Committee, Gilead, Inercept, Bristol-Myers Squibb; Grant/
Research Support: Intercept, Ocera, Merck, Lumena
Nancy Reau - Advisory Committees or Review Panels: Jannsen, Merck, AbbVie,
Intercept, Salix, BMS, Jannsen; Grant/Research Support: Merck, Gilead, BMS,
AbbVie, Jannsen, BI
Helen S. Te - Advisory Committees or Review Panels: BMS; Grant/Research
Support: Abbvie, Conatus, BMS
The following authors have nothing to disclose: Adam E. Mikolajczyk, Jeanne M.
Farnan, John F. McConville, Andrew I. Aronsohn
545
High Rates of Hepatitis C Virus Infection Among Inpatient
Baby Boomers in an Urban Hospital: a model to
improve linkage to care
Aparna Goel 1 , Lismeiry Paulino 2 , Douglas Dieterich 2 , Ponni V.
Perumalswami 2 ; 1 Gastroenterology, Icahn School of Medicine
Mount Sinai, New York, NY; 2 Liver Diseases, Icahn School of
Medicine Mount Sinai, New York, NY
Background: New York State passed legislation that took effect
in January 2014 requiring healthcare providers to offer Hepatitis
C Virus (HCV) screening to all inpatient baby boomers
and link infected persons to care. Our aims are to determine
the prevalence of HCV-positive baby boomers admitted to an
urban, tertiary care hospital and evaluate the sequential impact
of an electronic medical record (EMR) prompt, provider education,
and data feedback to providers on HCV screening
and linkage to care rates. Methods: The results of HCV antibody
(Ab) tests for individuals born 1945-1965 with inpatient
encounters at Mount Sinai were obtained from November
2013 through April 2015. The type of medical service, level
of provider and patient demographics were collected. HCV
screening and linkage to care rates before and after a series
of interventions were compared: a birth cohort-selective EMR
prompt was implemented in January 2014, comprehensive
education for housestaff and nurses occurred from July-September
2014, monthly data feedback to nurses with screening
rates began in October 2014 and finally patient navigation
was implemented in May 2015. Results: There were 23,835
inpatient baby boomer encounters during the study period.
The median age was 60 years with 56% male and 33% Hispanic.
Overall, 34% had a documented HCV Ab test and
13% (n=1,036) were positive. Screening rates did not significantly
rise following an EMR prompt (p=0.92), education
(p=0.86) or with data feedback to nursing managers (p=0.42).
Provider education and data feedback interventions led to a
rise in newly diagnosed HCV-positive rates from 6% to 15%
(p576,000
patients receiving AMA testing between January 2010 and
December 2013 in a large US commercial laboratory database.
Patients were considered AMA positive if the antibody
titer was > 1:20 or M2 antibody was > 25.0 U. We examined
geographic distribution at a 3-zip code level. Results: 16,492
patients tested AMA positive and had at least 1 ALP measure
over the 4 year period. 5,380 had an ALP >120 U/l before or
within 30 days of their first AMA+ test and were classified as
having probable PBC. There were clear patterns of increased
concentration of incident PBC patients (from west to east):
Southeastern tip of the Alaskan spur; Santa Barbara/Ventura
and inland central California; western Dakotas’ border; central
Oklahoma including Oklahoma City; western Texas and Houston;
Indiana just north of Louisville, Kentucky; an area of the
Appalachians spanning southeastern New York, southern Pennsylvania,
and the northern West Virginia border; and Florida
(excluding the Pan Handle). These areas were not associated
with age, race/ethnicity, urban concentration, or elevation.
Conclusion: These analyses indicate that there are clusters of
incident patients in geographically diverse areas in the United
States. Additional analyses are required to determine if there
may be geographic or demographic factors underlying these
variations.