studies

HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 483A
549
Engagement in care of high risk hepatitis C patients
with interferon-free therapies
John Dever 1,2 , Julie Ducom 1 , Ariel Ma 1 , Michael Yang 1 , Erika
Cherk 1 , Ann Herrin 1 , Erik J. Groessl 1,2 , Samuel B. Ho 1,2 ; 1 VA San
Diego Healthcare System, San Diego, CA; 2 University of California,
San Diego, San Diego, CA
Objectives: New interferon-free direct acting antiviral (DAA)
treatments have the potential to expand the numbers of patients
receiving treatment for hepatitis C virus (HCV); however patient
access and willingness to engage in care is unknown. Our
aim was to determine patient engagement and patient-related
barriers to care for accessing new interferon-free DAA in a realworld
practice setting. Methods: Patients with viremic HCV and
high-risk for fibrosis by FIB-4 score were identified using the
national VA HCV registry within the San Diego VA Healthcare
System in October 2014. Patients were categorized as actively
involved in HCV clinic care or those who were not seen in
HCV clinic within the previous 6 months and without a future
appointment. Patients were contacted by letter and phone call
and notified of the availability of new more effective DAA treatments
and the consequences of not receiving treatment, and
invited to schedule an appointment in HCV clinic. Patient characteristics
and subsequent outcomes were determined using
medical records. Logistic regression was used to examine factors
associated with willingness to engage in care. Results:
481 patients were found to have FIB-4 > 2.4 (307 with FIB-4
> 3.25 with high likelihood of cirrhosis). Of the 481 patients,
177 patients (37%) were actively followed in clinic and eligible
for treatment. Treatment ineligible included 24 (5%) in
hospice or deceased, 66 (14%) relocated, and 12 (2%) with
severe comorbidity. 202 treatment eligible patients (42%) were
identified as never seen by a HCV clinic provider or lost to follow-up.
Of these, 123 (61%) remained non-engaged and gave
no response to outreach (follow up 2-6 mo), 6 patients (3%)
declined evaluation and treatment, and 74 (36%) responded
and engaged with HCV clinic. Non-engaged patients compared
with engaged were more likely to have been homeless
(48 vs 28%), have active alcohol/drug use (44 vs 31%), psychiatric
diagnoses (69 vs 63%), and # co-morbid disorders
(3.17 vs 3.07). Significant variables in logistic regression for
non-engagement included history of homelessness, COPD, and
hypertension. Conclusions: Among treatment-eligible, high priority
HCV patients most at risk for advanced fibrosis that were
not currently attending HCV clinic, 64% were unable or unwilling
to engage in HCV care after a one time outreach (32% of
the total treatment eligible). Homelessness and certain comorbidities
are significant factors related to non-engagement.
These data indicate that more sustained or intensive outreach
efforts are needed in order to effectively expand access to
many of those most in need of treatment.
Disclosures:
Samuel B. Ho - Grant/Research Support: Genentech, Gilead; Speaking and
Teaching: Prime Education, Inc
The following authors have nothing to disclose: John Dever, Julie Ducom, Ariel
Ma, Michael Yang, Erika Cherk, Ann Herrin, Erik J. Groessl
550
Thirty-day Readmission for Infection Following Liver
Transplant is Associated with Increased Mortality
Lorna M. Dove 1 , Daniel J. Lerner 2 ; 1 Internal Medicine, Columbia
University College of Physicians and Surgeons, New York, NY;
2 Health Sciences West, Scarsdale, NY
BACKGROUND: Over thirty percent of patients are readmitted
within 30 days of liver transplantation (30dRA). The role of
infection in 30dRA of these immunosuppressed patients is not
well defined. PURPOSE: The purpose of this study is to define
the incidence, etiology, and cost of 30dRA for infection following
liver transplantation (LT). METHODS: Utilizing the Agency
for Healthcare Research and Quality’s Healthcare Cost and
Utilization Project’s State Independent Databases for 4 geographically
distinct states: Florida, Massachusetts, New York,
and Washington, we identified patients who underwent LT in
2012, based on the ICD-9-CM code for LT, 50.59. Patients
with a 30dRA following LT were divided into 2 groups: those
with and without an infection-related principal diagnosis (IRPD)
for the 30dRA. Patients with a 30dRA for rehabilitation on the
day of discharge were excluded. Approximately 8% of 30dRA
were not captured because they occurred in the following
year. RESULTS: The incidence of 30dRA following LT was 30%
(332/1099). Nineteen percent (64/332) of those 30dRA had
an IRPD. There was no significant difference in the mean age,
gender, race, number of chronic conditions, primary payor, or
median household income between the two groups. There were
21 different IRPD, and the most common were postoperative
infection (31%; 20/64), intestinal infection due to C. difficile
(16%; 10/64), unspecified septicemia (13%; 8/64), and urinary
tract infection (8%; 5/64). Patients with a 30dRA for an
IRPD were more likely to die during that 30dRA, compared
to those with a non-IRPD (5% vs. 0%; P