Houston VA HSR&D Center of Excellence, Health Services Research and Development Service, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Section of Gastroenterology, Department of Medicine, Baylor College of Medicine, Houston, Texas.
BACKGROUND & AIMS:
Process of care-based measures are commonly used to assess the quality of medical care provided to patients with chronic hepatitis C virus (HCV) infection. However, the links between these processes and patient outcomes are not clear.
We conducted a large retrospective cohort study of 34,749 patients with HCV infection identified from the national Veterans Administration HCV Clinical Case Registry between 2003 and 2006. We examined the relationship between meeting process based measures of HCV care (categorized into pre-treatment, preventive or comorbid care, and treatment monitoring domains) and antiviral treatment-related outcomes. For each domain, we defined optimum care as receipt of all indicated care processes in that domain. Study endpoints were rates of antiviral treatment, treatment completion, and sustained viral response (SVR), adjusted for patients' demographics, comorbidities, use of health services, and intra-facility clustering.
Of the patients analyzed, 18% received antiviral treatment; 49% of these completed treatment and 32% had a SVR. Patients that received optimum pretreatment care were significantly more likely to receive antiviral treatment (odds ratio [OR], 3.2; 95% confidence interval [CI], 2.9-3.5), complete treatment (OR, 1.26; 95% CI, 1.13-1.43), and achieve a SVR (OR, 1.29; 95% CI, 1.01-1.65), than those with suboptimum pretreatment care. Optimum preventive or comorbidity care was also independently associated with receipt of antiviral treatment (OR, 1.36; 95% CI, 1.23-1.51), but not with completion of treatment or SVR. Optimum treatment monitoring was associated with a non-significant trend toward achieving a SVR (OR, 1.22; 95% CI, 0.95-1.56).
Optimum care for HCV infection-particularly the care delivered before treatment-is associated with increase rates of treatment and SVR. These data could be used to guide clinical policy as newer, more-effective treatments become available.