Screening high-risk Veterans for cirrhosis: taking a stepwise population health approach
Abstract Background Because cirrhosis is often unrecognized, we aimed to develop a stepwise screening algorithm for cirrhosis in the Veterans Health Administration (VHA) and assess this approach’s feasibility and acceptability. Methods VHA hepatology clinicians (“champions”) were invited to particip...
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BMC
2025-01-01
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| Series: | BMC Health Services Research |
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| Online Access: | https://doi.org/10.1186/s12913-025-12216-8 |
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| author | Jonathan Dounel Carolyn Lamorte Heather Patton Ponni Perumalswami Heather McCurdy Nicole J. Kim Lauren A. Beste Dawn Scott Jessimarie Casey Patrick Spoutz Linda Chia Yiwen Yao Elliott Lowy Sandra Gibson Timothy R. Morgan Shari S. Rogal |
| author_facet | Jonathan Dounel Carolyn Lamorte Heather Patton Ponni Perumalswami Heather McCurdy Nicole J. Kim Lauren A. Beste Dawn Scott Jessimarie Casey Patrick Spoutz Linda Chia Yiwen Yao Elliott Lowy Sandra Gibson Timothy R. Morgan Shari S. Rogal |
| author_sort | Jonathan Dounel |
| collection | DOAJ |
| description | Abstract Background Because cirrhosis is often unrecognized, we aimed to develop a stepwise screening algorithm for cirrhosis in the Veterans Health Administration (VHA) and assess this approach’s feasibility and acceptability. Methods VHA hepatology clinicians (“champions”) were invited to participate in a pilot program from June 2020 to October 2022. The VHA Corporate Data Warehouse was queried to identify Veterans with possible undiagnosed cirrhosis using Fibrosis-4 (FIB-4) ≥ 3.25 and at least one risk factor for liver disease (e.g., obesity), and generate an age-stratified sample. Champions at four sites reviewed charts to confirm eligibility and contacted Veterans to offer further evaluation with elastography. Feasibility was defined as protocol implementation with completion of at least one elastography test and acceptability was defined based on Veteran- and clinician-reported surveys. Participation in the program, patient outcomes, adaptations to the protocol, and implementation barriers were also assessed. Results Four sites were able to implement the screening protocol. Adaptations included type of outreach (primary care vs. hepatology, phone vs. mail) and type of elastography used. One site chose to refer patients with clear evidence of cirrhosis directly to hepatology (n = 12) rather than to elastography. Key implementation barriers included staffing, primary care provider (PCP) comfort with interpreting and communicating results, and appointment availability during the COVID-19 pandemic. Of 488 patients whose charts were reviewed, 230 were excluded from outreach based on predefined criteria (e.g., advanced cancer, prior or current referral to hepatology). Champions and PCPs attempted to contact 165 of 246 Veterans who were deemed eligible for evaluation with elastography. Among 53 Veterans who completed elastography, 22 (42%) had findings consistent with significant fibrosis and were referred to hepatology. Clinicians and Veterans reported high acceptability of the program on surveys (80% of Veterans who completed survey). Conclusions This pilot demonstrated the feasibility, acceptability, and challenges of a multisite approach to cirrhosis screening. |
| format | Article |
| id | doaj-art-868265279bb34cbbbb3d5041f81c504a |
| institution | Kabale University |
| issn | 1472-6963 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj-art-868265279bb34cbbbb3d5041f81c504a2025-02-02T12:14:01ZengBMCBMC Health Services Research1472-69632025-01-0125111110.1186/s12913-025-12216-8Screening high-risk Veterans for cirrhosis: taking a stepwise population health approachJonathan Dounel0Carolyn Lamorte1Heather Patton2Ponni Perumalswami3Heather McCurdy4Nicole J. Kim5Lauren A. Beste6Dawn Scott7Jessimarie Casey8Patrick Spoutz9Linda Chia10Yiwen Yao11Elliott Lowy12Sandra Gibson13Timothy R. Morgan14Shari S. Rogal15VA San Diego Healthcare SystemVA Center for Health Equity Research and PromotionVA San Diego Healthcare SystemVA Ann Arbor Healthcare SystemVA Ann Arbor Healthcare SystemDivision of Gastroenterology, University of WashingtonVA Puget Sound Health Care System Seattle DivisionVA Central Texas Healthcare SystemVA Pittsburgh Healthcare SystemPharmacy Benefits Management, VA Northwest Health Network (VISN 20)Pharmacy Benefits Management, VA Northwest Health Network (VISN 20)VA Salt Lake City Health Care SystemVA Puget Sound Health Care System Seattle DivisionVA Center for Health Equity Research and PromotionVA Long Beach Healthcare SystemVA Center for Health Equity Research and PromotionAbstract Background Because cirrhosis is often unrecognized, we aimed to develop a stepwise screening algorithm for cirrhosis in the Veterans Health Administration (VHA) and assess this approach’s feasibility and acceptability. Methods VHA hepatology clinicians (“champions”) were invited to participate in a pilot program from June 2020 to October 2022. The VHA Corporate Data Warehouse was queried to identify Veterans with possible undiagnosed cirrhosis using Fibrosis-4 (FIB-4) ≥ 3.25 and at least one risk factor for liver disease (e.g., obesity), and generate an age-stratified sample. Champions at four sites reviewed charts to confirm eligibility and contacted Veterans to offer further evaluation with elastography. Feasibility was defined as protocol implementation with completion of at least one elastography test and acceptability was defined based on Veteran- and clinician-reported surveys. Participation in the program, patient outcomes, adaptations to the protocol, and implementation barriers were also assessed. Results Four sites were able to implement the screening protocol. Adaptations included type of outreach (primary care vs. hepatology, phone vs. mail) and type of elastography used. One site chose to refer patients with clear evidence of cirrhosis directly to hepatology (n = 12) rather than to elastography. Key implementation barriers included staffing, primary care provider (PCP) comfort with interpreting and communicating results, and appointment availability during the COVID-19 pandemic. Of 488 patients whose charts were reviewed, 230 were excluded from outreach based on predefined criteria (e.g., advanced cancer, prior or current referral to hepatology). Champions and PCPs attempted to contact 165 of 246 Veterans who were deemed eligible for evaluation with elastography. Among 53 Veterans who completed elastography, 22 (42%) had findings consistent with significant fibrosis and were referred to hepatology. Clinicians and Veterans reported high acceptability of the program on surveys (80% of Veterans who completed survey). Conclusions This pilot demonstrated the feasibility, acceptability, and challenges of a multisite approach to cirrhosis screening.https://doi.org/10.1186/s12913-025-12216-8VeteransScreeningCirrhosisPrimary careElastography |
| spellingShingle | Jonathan Dounel Carolyn Lamorte Heather Patton Ponni Perumalswami Heather McCurdy Nicole J. Kim Lauren A. Beste Dawn Scott Jessimarie Casey Patrick Spoutz Linda Chia Yiwen Yao Elliott Lowy Sandra Gibson Timothy R. Morgan Shari S. Rogal Screening high-risk Veterans for cirrhosis: taking a stepwise population health approach BMC Health Services Research Veterans Screening Cirrhosis Primary care Elastography |
| title | Screening high-risk Veterans for cirrhosis: taking a stepwise population health approach |
| title_full | Screening high-risk Veterans for cirrhosis: taking a stepwise population health approach |
| title_fullStr | Screening high-risk Veterans for cirrhosis: taking a stepwise population health approach |
| title_full_unstemmed | Screening high-risk Veterans for cirrhosis: taking a stepwise population health approach |
| title_short | Screening high-risk Veterans for cirrhosis: taking a stepwise population health approach |
| title_sort | screening high risk veterans for cirrhosis taking a stepwise population health approach |
| topic | Veterans Screening Cirrhosis Primary care Elastography |
| url | https://doi.org/10.1186/s12913-025-12216-8 |
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