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Takeaway: This evaluation—the first large-scale longitudinal study of implementation strategies for hepatitis C best practices conducted nationwide—assessed how VA site-level strategies were associated with the initiation of HCV treatment. Over 130 sites, the most commonly endorsed strategies were: data warehousing techniques, tailoring strategies to deliver HCV care, and intervening with patients to promote uptake and adherence to HCV treatment.
Hepatitis C virus (HCV) infection is a leading cause of cirrhosis and liver cancer in the United States, and is more common among Veterans than in the US population as a whole. VA is the single largest provider of HCV care in the country, with approximately 168,000 Veterans who were potentially eligible for treatment in 2015. New medications that have much higher cure rates have become the new evidence-based practice. To increase access to these treatments, VA established regional Hepatitis Innovation Teams (HITs), organized into a national learning collaborative and tasked with identifying local needs and selecting implementation strategies to increase treatment initiations.
The aim of this evaluation—the first large-scale longitudinal study of implementation strategies nationwide—was to assess how VA site-level strategies were associated with the initiation of HCV treatment. An HCV provider at each VA site (N = 130) was asked to complete an online survey examining the use of 73 implementation strategies organized into nine clusters as described by the Expert Recommendations for Implementing Change (ERIC) study. Using VA data, investigators examined the number of Veterans initiating treatment for HCV, or "treatment starts,” from FY15 through FY18.
VA sites used an average of 22-25 strategies per year to implement new hepatitis C treatments. The most commonly endorsed strategies over this four-year evaluation included: data warehousing techniques, tailoring strategies to deliver HCV care, and intervening with patients to promote uptake and adherence to HCV treatment. The least commonly endorsed strategies were in the financial efforts cluster. One strategy ("make efforts to identify early adopters to learn from their experiences") was significantly associated with treatment starts in all four years. The majority of the strategies used were a direct result of involvement in the HIT Collaborative. This national implementation effort contributed to the tremendous success of VA in treating over 85% of all Veterans with hepatitis C in under five years.
The evaluators include Shari Rogal (VA Pittsburgh Healthcare System, Center for Health Equity Research & Promotion) and Vera Yakovchenko (Edith Nourse Rogers VA Hospital, Bridging the Care Continuum QUERI). This work was conducted with the support of the Office of HIV, Hepatitis, and Related Conditions (HHRC) and the national Hepatic Center for Restructuring Care. HHRS additionally supports programs to improve cirrhosis care and HIV prevention and care across VA.
Rogal S, Yakovchenko V, Waltz T, et al. The association between implementation strategy use and the uptake of hepatitis C treatment in a national sample. Implementation Science. May 11, 2017.
