studies

482A AASLD ABSTRACTS HEPATOLOGY, October, 2015
Disclosures:
Tracy J. Mayne - Employment: Intercept Pharmaceuticals
Herbert Swanson - Management Position: Intercept
David Shapiro - Employment: Inttercept Pharmaceuticals; Management Position:
Intercept Pharmaceuticals; Stock Shareholder: Intercept Pharmaceuticals
W. Ray Kim - Advisory Committees or Review Panels: Bristol Myers Squibb,
Gilead Sciences, Abbvie, Merck
The following authors have nothing to disclose: Keith D. Lindor
547
A qualitative assessment of factors impacting adoption
and implementation of USPSTF age-based Hepatitis C
Virus screening guidelines
Amy B. Jessop; HepTREC, University of the Sciences in Philadelphia,
Philadelphia, PA
Background: Baby boomers comprise 70% of U.S. Hepatitis
C (HCV) cases, yet many remain unaware of their infection.
The 2012 CDC and 2013 USPSTF HCV screening guidelines
that expanded to include one-time screening for those born
between 1945 and 1965 were developed to increase identification
of those infected. Insurer policies require or encourage
screening within primary care or family practice settings,
therefore, improvements will be realized only if primary care
providers adopt the guidelines. This qualitative study examines
the awareness and adoption of prevention practice guidelines,
particularly the enhanced USPSTF HCV screening guideline in
a large, suburban family practice setting. Methods: Data collection
employed individual interviews conducted at the practice
site using a semi-structured interview guide developed,
assessed for content validity through literature and expert
review and pilot testing with three practicing primary care
physicians. The family practice site selected for examination
is a community-based family practice and resident training
program. Interviews with all resident (12) and attending physicians
(5) and advanced practice nurse (NP) were taped and
completed between Dec 2014 and Feb 2015. They considered
knowledge and beliefs about practice guidelines (in general
and the USPSTF enhanced HCV guideline in particular) and
self-assessed screening rates. Researchers independently, then
collectively, reviewed transcriptions, assessing responses and
identifying common and emergent themes. Results: All subjects
viewed practice guidelines as useful tools. Attending physicians
reported self-selection of guidelines to adopt and implement
while residents tended to follow advice of the attending
physicians to which assigned. Source of the guideline played
a deciding role in which guidelines were adopted. Awareness
of the expanded USPSTF HCV screening guideline varied by
position, with the NP and attending physicians most aware,
although knowledge of guideline details was limited; some
considered their patients to be of low-risk for HCV infection
and estimates of individual and group HCV screening rates
were low (2-25%). Subjects caring for an HCV-affected patient
reported greater importance to screening. Smart tools, prompting
screening at point of care were deemed likely to improve
practice. Conclusion: Preventive practice guidelines are well
accepted, but knowledge of and attitudes about age-based
HCV screening guidelines is low and lack of reminders at pointof-care
limit screening initiation. Improved education and systems-based
approaches to improve screening practices are
essential to reap benefits of expanded guidelines.
Disclosures:
The following authors have nothing to disclose: Amy B. Jessop
548
Outreach invitations improve HCC surveillance rates:
A Randomized Controlled Trial in a Safety-Net Health
System
Amit G. Singal 1 , Jasmin A. Tiro 2 , Katharine McCallister 2 , Caroline
A. Mejias 2 , Lei Xuan 2 , Ethan Halm 1 ; 1 Internal Medicine, University
of Texas Southwestern, Irving, TX; 2 University of Texas Southwestern,
Dallas, TX
Background: Hepatocellular carcinoma (HCC) surveillance
is associated with improved survival, but its effectiveness is
limited by underuse, particularly in underserved populations.
Aim: Compare the effectiveness of mailed outreach and patient
navigation to increase HCC surveillance rates in a racially
diverse cohort of patients Methods: Patients with documented
or suspected cirrhosis at a safety-net health system were randomized
to receive mailed outreach invitations for surveillance
ultrasonography, mailed outreach plus patient navigation, or
usual care. Documented cirrhosis was defined using ICD-9
codes, and suspected cirrhosis was defined as AST to platelet
ratio index (APRI) ≥1.5 in the presence of liver disease. We
excluded those with Child C cirrhosis who were not transplant
candidates and/or significant comorbid conditions given limited
benefit of surveillance. Patients who did not respond to
outreach invitations within 2 weeks received up to 3 reminder
telephone calls. The primary study outcome was completion of
surveillance ultrasound within 6 months of randomization. We
used intent- to-screen principle for analyses. We are randomizing
1800 patients in groups of 300 (100 patients/arm), with
results of the first 2 groups presented here. Results: Baseline
patient characteristics (n=600) across the arms were similar.
Mean age was 55 years and 60% were men. The cohort was
racially diverse with 36% Black, 35% Hispanic, and 28%
White. Most (79%) had documented cirrhosis, while 21% had
suspected cirrhosis. Cirrhosis was due to HCV in 54%, alcohol
19%, NASH 15%, and HBV 4%. Rates of scheduled surveillance
ultrasound were significantly higher in the outreach/navigation
(34.0%) and outreach alone (26.5%) arms than usual
care (11.5%; p