Original Research

Hepatitis C Clinical Dashboards: Improving Liver Specialty Care Access and Quality

Clinical dashboards can improve the health management of the HCV population within the VHA by empowering health care practitioners to deliver wide and effective HCV care.

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References

The VHA cares for 170,000 patients with chronic hepatitis C virus (HCV) infection, making it the largest single provider of medical care to chronic HCV patients in the U.S. 1 Although HCV treatment rates within the VHA outpace those of the private sector, only half of patients with HCV infection within the VHA have accessed a liver specialist and less than a quarter have received antiviral medication. 2-4

Newer HCV treatment regimens promise treatment sustained virologic response (SVR) rates—a marker of viral clearance posttreatment—of ≥ 90% in most cases but require careful patient selection and management. 5 In particular, the estimated 24% of patients with HCV infection with advanced liver disease require more rapid consideration for therapy to reduce complications of cirrhosis such as liver failure, hepatocellular carcinoma, and death. 6 With the advent of promising HCV therapies and rising rates of cirrhosis, there is an urgent need for population health management approach to deliver HCV care more widely and effectively. 5,7

Rationale for Clinical Dashboards

Although the VHA hosts the largest integrated electronic medical record (EMR) system in the U.S., an EMR on its own does not guarantee improved patient care or access. 8 EMRs can be used to document health care delivery, but they do not routinely provide information about the burden of disease in a population, nor do they identify patients most in need of care.

Clinical dashboards are tools that are geared to provide clinicians with relevant data to improve patient care. Early clinical dashboard development across the VHA was primary care focused, targeting patients with diabetes, ischemic heart disease, and hypertension. This national primary care dashboard provides clinically relevant, actionable data and enables the clinical provider to track patient progress. In addition, regional data can be aggregated for use by VISN managers.
While the impact of dashboards on quality of care is not well investigated, it remains a vital tool with the potential to transform care. 9

HCV dashboards have been developed by individual VISNs and facilities across the VHA. HCV dashboards serve to identify patients most in need of antiviral therapy, expand outreach to those previously unseen by specialty care, sort patients by severity of liver disease, track treatment status, and calculate SVR.

Current HCV dashboards incorporate elements derived from the VA Corporate Data Warehouse (CDW), a national VA data repository consisting of data from all facilities’ electronic medical record systems. Updated information from the previous day is made available in VISN data warehouses and is refreshed nightly. The final result is user-friendly clinical data available in near-real time to dashboard users.

VISN 21 HCV Dashboard

Purpose and Elements

The VISN 21 HCV dashboard will be discussed as a prototype. Graphics of the VISN 21 dashboard interface are presented in Figure 1 and Figure 2. The VISN 21 HCV dashboard was developed by pharmacists with specialty training in medical informatics, health care analytics, and data management. The dashboard addresses 3 previously unmet needs in HCV care: population management, patient treatment outcome tracking, and administrative planning.

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