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Abstract Details
The Hepatic Innovation Team Collaborative: A Successful Population-Based Approach to Hepatocellular Carcinoma Surveillance
Cancers (Basel). 2021 May 7;13(9):2251. doi: 10.3390/cancers13092251.
Shari S Rogal12, Vera Yakovchenko3, Rachel Gonzalez4, Angela Park5, Lauren A Beste67, Karine Rozenberg-Ben-Dror8, Jasmohan S Bajaj910, Dawn Scott11, Heather McCurdy12, Emily Comstock13, Michael Sidorovic14, Sandra Gibson1, Carolyn Lamorte1, Anna Nobbe15, Maggie Chartier16, David Ross16, Jason A Dominitz1718, Timothy R Morgan1920
Author information
1Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive (151C), Pittsburgh, PA 15240, USA.
2Departments of Medicine and Surgery, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA 15240, USA.
3Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Building 70, Bedford, MA 01730, USA.
4Department of Veterans Affairs, Sierra Pacific Veterans Integrated Service Network, Pharmacy Benefits Management, Mather, CA 94523, USA.
5Office of Healthcare Transformation, Department of Veterans Affairs, 810 Vermont Avenue, Washington, DC 20420, USA.
6Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, USA.
7General Medicine Service, VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA 98108, USA.
8Veteran Affairs Great Lakes Health Care System, VISN 12 PBM, 11301 W Cermak Road, Ste 810, Westchester, IL 60154, USA.
9Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University, 1200 E Broad Street, West Hospital, 14th Floor, Box 980341, Richmond, VA 23298, USA.
10Division of Gastroenterology, Central Virginia Veterans Affairs Healthcare System, 1201 Broad Rock Blvd, Richmond, VA 23249, USA.
11Department of Medicine, Central Texas Veterans Healthcare System, 1901 Veterans Memorial Drive, Temple, TX 76504, USA.
12VA Ann Arbor Healthcare System, 2215 Fuller Rd, Ann Arbor, MI 48105, USA.
13Department of Infectious Diseases, Baltimore VA Medical Center, 10 N Greene Street, Baltimore, MD 21201, USA.
14Salisbury VA Medical Center, 1601 Brenner Avenue, Salisbury, NC 28144, USA.
15Digestive Disease Section, Cincinnati VA Medical Center, 3200 Vine Street, Cincinnati, OH 45220, USA.
16HIV, Hepatitis, and Related Conditions, Office of Specialty Care Services (10P11I), Department of Veterans Affairs, 810 Vermont Avenue, Washington, DC 20420, USA.
17Gastroenterology Section, Veterans Affairs Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA 98108, USA.
18Division of Gastroenterology, Department of Medicine, RR-512, Health Sciences Building, University of Washington School of Medicine, Box 356420, 1959 NE Pacific Street, Seattle, WA 98195, USA.
19Gastroenterology Section, VA Long Beach Healthcare System, 5901 E 7th Street, Long Beach, CA 90822, USA.
20Division of Gastroenterology, Department of Medicine, University of California, 333 City Blvd. West, Suite 400, Orange, CA 92868, USA.
Abstract
After implementing a successful hepatitis C elimination program, the Veterans Health Administration's (VHA) Hepatic Innovation Team (HIT) Collaborative pivoted to focus on improving cirrhosis care. This national program developed teams of providers across the country and engaged them in using systems redesign methods and population health approaches to improve care. The HIT Collaborative developed an Advanced Liver Disease (ALD) Dashboard to identify Veterans with cirrhosis who were due for surveillance for hepatocellular carcinoma (HCC) and other liver care, promoted the use of an HCC Clinical Reminder in the electronic health record, and provided training and networking opportunities. This evaluation aimed to describe the VHA's approach to improving cirrhosis care and identify the facility factors and HIT activities associated with HCC surveillance rates, using a quasi-experimental design. Across all VHA facilities, as the HIT focused on cirrhosis between 2018-2019, HCC surveillance rates increased from 46% (IQR 37-53%) to 51% (IQR 42-60%, p < 0.001). The median HCC surveillance rate was 57% in facilities with high ALD Dashboard utilization compared with 45% in facilities with lower utilization (p < 0.001) and 58% in facilities using the HCC Clinical Reminder compared with 47% in facilities not using this tool (p < 0.001) in FY19. Increased use of the ALD Dashboard and adoption of the HCC Clinical Reminder were independently, significantly associated with HCC surveillance rates in multivariate models, controlling for other facility characteristics. In conclusion, the VHA's HIT Collaborative is a national healthcare initiative associated with significant improvement in HCC surveillance rates.