Objective: Maternal hepatitis C virus (HCV) infection has increased by 400%, which has led to increased prevalence of HCV infection in children, with 5 to 10% of newborns of mothers with HCV being infected. Suboptimal HCV screening rates and diagnosis in children have precluded curative treatment, which is available starting at age 3. To address these gaps, we aimed to increase screening of children at risk and diagnosis and treatment of children with HCV infection in New Mexico. Methods: From July 2020-August 2021, quality improvement efforts were conducted by an improvement team including clinical staff from the UNMH pediatric gastroenterology division and Envision NM 2.0 experts in improvement science. A pediatric HCV registry was developed to compile patient demographic and health data. Results: Key Plan-Do-Study-Act cycles included: optimizing education on universal pregnancy screening and the pediatric referral process for clinics, hospitals, and payers; collaborating to increase coordination with the public health sector; addressing medication pre-authorization with pharmacy; and improving access to care coordination for families. Compared to July 2019-June 2020, the pediatric HCV clinic had a 66% increase in referrals, a 95% increase in scheduled clinic visits, and a 40% increase in HCV treatment completers. There was also a 67% increase in no shows for clinic appointments. The 30 pediatric patients enrolled in the HCV registry are 7.1 ± 5.1 (standard deviation) years old, 52% male, 87% Hispanic or Latino/a, and 87% Medicaid insured. Almost all children (88%) acquired HCV infection via vertical transmission and 68% were not in parental custody. Conclusion: Application of QI methodology increased medical provider and children’s caregivers’ awareness and engagement in accessing HCV healthcare available for at-risk children in NM. More QI efforts should be accelerated to identify best practices for pediatric HCV screening, referral, and diagnosis amidst a national HCV epidemic.
Vallabhan, Monique. "Quality Improvement Project Improves Pediatric Hepatitis C Healthcare Access." (2022). https://digitalrepository.unm.edu/hsc_2022_pediatric_research/22