An Electronic Web-based HCV Quality of Care Performance Measurement Program for NYC and NYS. Jeremy Fagan, PhD March QAC Meeting 3/10/2016

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1 An Electronic Web-based HCV Quality of Care Performance Measurement Program for NYC and NYS Jeremy Fagan, PhD March QAC Meeting 3/10/2016

2 HCV Treatment TimeLine 1 st GEN PIs Boceprevir Telaprevir All-Oral, Combination drugs, tablets, IFN-& RBV free introduced Sofosbuvir/ledipasvir Daclatasvir/asunaprevir Paritaprevir/r-ombitasvir/dasbuvir/ledipasvir MK2(grazoprevir/elbasvir) PEG-IFN + RBV 2nd wave PI Simeprevir Sofosbuvir/(IFN-free and with PEG-IFN + RBV) Daclatasvir/ asunaprevir /beclabuvir MK2(MK-5172/NI/NS5A) Sofosbuvir/GS-5816{+/- PI and or NNI) ABT-493/ABT-530

3 Process: Delphi Method Survey 1: What are the 5 most important aspects of care for HCV monoinfection from screening through treatment and follow-up that should be considered when assessing the quality of care? Grouped responses into indicator categories, ranked by number of responses Survey 2: Participants re-ranked and commented on indicators Adjusted ranking, removed categories Survey 3: Approval of ranking & final comments

4 Hepatitis C Screening Indicators Diagnosis of HCV Viremia-Percentage of HCV seropositive patients who received an HCV RNA assay. Linkage to Care-Percentage of HCV infected patients who were linked to HCV care.

5 Alcohol & SU Screening & Education Indicators Alcohol Education-Part 1(NYS)-Percentage of HCV seropositive patients who were assessed for alcohol use. Alcohol Education-Part 2(NYS)-Percentage of HCV seropositive patients who were educated/counseled regarding alcohol use. Substance Use Screening and Counseling (NYS) -Percentage of HCV seropositive patients who underwent substance use screening & counseling.

6 HIV, HAV and HBV Screening Indicators HIV Testing-Percentage of HCV seropositive patients who were screened and tested for HIV. Hepatitis A Virus Screening(NYS)-Percentage of HCV seropositive patients who were screened for HAV immunity. Hepatitis A Virus Immunization-Percentage of HCV seropositive, HAV negative patients who were vaccinated against HAV. Hepatitis B Virus Screening -Percentage of HCV seropositive patients who were screened for HBV infection. Hepatitis B Virus Immunization-Percentage of HCV seropositive, HBV negative patients who were vaccinated against HBV.

7 HCV Treatment Preparation Indicators Fibrosis Staging-Percentage of HCV infected patients who were assessed for liver fibrosis. Adherence Assessment & Counseling-Barriers Discussion(NYS)- Percentage of HCV infected patients who had an assessment of the ability to successfully complete HCV treatment and were counseled accordingly. HCV treatment Initiation-Percentage of HCV infected patients who initiate HCV treatment

8 HCV Treatment Initiation, Counseling & Monitoring Indicators Genotype Testing Prior to Treatment-Percentage of HCV infected patients who received a HCV Genotype Test prior to treatment initiation. *Treatment Initiated Consistent with Latest Guidelines-Percentage of HCV infected patients whose treatment aligns with the NYSDOH-AI HCV guidelines or AASLD guidelines. Adherence Assessment & Counseling-Education during Treatment(NYS)- Percentage of HCV infected patients who received adherence assessment while on HCV therapy. *RNA Monitoring after treatment initiation(nyc)-percentage of HCV infected patients receiving treatment who received RNA monitoring at week 4 of HCV therapy. Assessment of Sustained Virologic Response (SVR) after treatment completion- Percentage of HCV infected patients who have completed a full course of treatment and have undetectable HCV RNA.

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10 Sample Reports

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14 Future directions Completion of ehepqual User Guide Finalization of ehepqual Administrative Reports ehepqual introductory webinar for NYS Funded sites in Late March Official pilot launch of ehepqual for NYS funded sites in Summer 2016

15 Acknowledgements Bruce Agins, MD, MPH Christine Kerr, MD Colleen Flanigan, RN,MS Hugh Dai, MD Minna Yoshikawa NYCDOHMH Mary Ford, MS Fabienne Laraque, MD, MPH HCV QAC sub-committee members