Full Duration Management of Hepatitis C in General Hospital via IT System ---- a case from Peking University People s Hospital

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1 Full Duration Management of Hepatitis C in General Hospital via IT System ---- a case from Peking University People s Hospital WEI Lai, Vice President, Peking University People s Hospital Oct 2nd, 2014

2 Introduction of PKUPH Introduction Hepatitis C Disease burden in China Monitoring of Potential population with HCV infection Consulting & Referral Infections reporting Follow up & collaborative studies with Dr. ASF Lok Future of Hepatitis C research in China

3 Introduction of Peking University People s Hospital & Peking University Hepatology Institute

4 Peking University People s Hospital (PKUPH) the first general hospital financed and operated by the Chinese nationals Dr. WU Lien-the, the founding director of PKUPH and a candidate for the 1935 Nobel Prize in Medicine Published by the Modern Hospital, a monthly magazine Chicago, U.S.A., in April 1917

5 History of PKUPH 1918 Peking University People s Hospital, originally named Peking Central Hospital, was founded at Baitasi, Beijing 1950 The hospital was donated to the Chinese Ministry of Health 1958 People s Hospital affiliated to Beijing Medical College 2000 After Beijing Medical University reunited with Peking University, the hospital was renamed Peking University People's Hospital 1946 Peking Central Hospital was renamed Central Union Hospital 1956 The hospital was renamed Beijing People's Hospital 1991 The Xizhimen campus opened 2006 A new inpatient building was built

6 Peking University People s Hospital (PKUPH) a comprehensive and multi-specialty hospital with three campuses located in the central part of Beijing Xizhimen Campus (1400 beds) Baitasi Campus (300 beds) China Beijing Qinghe Campus (500 beds)

7 Peking University Hepatology Institute Established in 1978 Invented the first HBV vaccine Invented the first generation of hepatitis B virus and hepatitis C virus diagnostic agent in China Comprehensive Institute Basic research Experimental diagnosis Medical care

8 Hepatitis C Disease burden in China

9 HBV Infection Reduction after Vaccination Program in 1992 HBsAg rates Fig. evaluation of the effect of the hepatitis B vaccine based on the HBsAg rates in the Chinese population Liu H, Ma Y, Wang H,et al. Vaccine. 2012

10 HCV infection among different population in China Population (Million) Anti-HCV(%) Estimated infected population (million) General population HIV infection(0.7) Dialysis(0.6) MSM(5-10) Sex Worker(6) DU(1.16) STD(6) Blood Donor(10) Organ Donor(0.0015) Other High Risk(10) 30 3 Total 10 Slide courtesy of Prof. ZHUANG Hui

11 Increasing Incidence of HCV In Mainland China from 2005 to 2013* 16 Incidence(1/100000) Year * China Health Statistics Year Book

12 Significant Differences between Reported New Cases 1 and the Corrected Estimates Annual HCV Incidence Reported Cases Corrected Estimates Year 1. Duan ZP et al. J Clin Gastroenterol. 2014; 2. Feng GS et al. ISPOR EU

13 18.88% 16.99% 15.52% 17.14% 24.48% 17.46% 16.37% 6.83% 57.95% 58.59% 4.4% 57.55% 5.32% 23.69% 24.48% 25.44% 54.95% 56.61% 56.48% 11.15% 9.29% 19.03% 20.75% 58.24% 57.76% 57.19% 2010-HBV 2011-HBV 2012-HBV 3.03% 2.83% 6.83% 42.32% 41.95% 23.69% 27.98% 28.28% 31.07% 56.61% 54.95% 2.74% 39.66% 2010-HCV 2011-HCV 2012-HCV Fig. The prevalence of HBV and HCV in Chinese with different ages

14 More Cirrhosis among naïve Chronic Hepatitis C Virus Infection National-wide survey in China 997 naïve patients from 28 university hospital 152 pt s were identified complications Others HCC 9% 3% 25% Splenomegaly without cirrhosis Decompensated cirrhosis 32% 31% Compensated cirrhosis CTP for cirrhotic patients (N = 101): - Class A: 59.4% - Class B: 33.7% - Class C: 6.9% Wei L, et al. AASLD Poster 412.

15 Predicted Cirrhosis and HCC by REVEAL/HCV Risk Model 1 Based on the Corrected Estimates of New Cases of HCV from 2005 to , , , ,000 Number of Cases 300, , , , , , , , ,301 50,000 38,680 - in 5 Years in 10 Years in 15 Years Estimated Cirrhosis Estimated HCC 1. Lee M-H et al. Plos One Feng GS et al. ISPOR EU. 2014

16 Interferon Intolerant Patients Naïve patients (N = 438) Complete Not complete Naïve patients 103 cases not complete Economic AE Withdraw ICF Null response adherence Death Wei L, et al. Unpublished

17 Monitoring Screening Consulting & Referral Infections reporting

18 If you were born during , talk to your doctor about getting tested for Hepatitis C. The only way to know if you have Hepatitis C is to get tested. Early detection can save lives MMWR

19 抗 -HCV in hospitalized patients 8 Xiangya 2 nd Hospital , cases, 抗 -HCV: 1.68% Anti-HCV(%) P<0.01 P<0.01 P< Cardiac surgery Other surgery Nephrology Hematology Other IM GY others Chen YL, et al Chin J Hospital Infection, 2007, 17(4):

20 In August 2014, the National Health and Family Planning Commission approved a national screening and management standard for HCV infection, organized by the Peking University Hepatology Institute

21 Recommendations were made to screen for HCV among persons: Who received blood transfusions before 1992; Who received medical or dental interventions in health-care settings where infection control practices are substandard; Who inject drugs, had tattoos, or body piercing; Who will have procedure

22 Isolated management of Hepatitis C previously LIS Anti-HCV Different System Different Patient Index LIS HCV RNA Consulting between depatments Referral waiting and delay Reporting waiting Follow up Where am I? Where to go?

23 Full Duration Management of Hepatitis C Monitoring &Screening LIS Working warning station Mobile phone Intervention message PDA

24 The hospital infection monitoring and early warning system laboratory anti- HCV repotting Full-time staff of Hospital infection Dpt. Informing Head of Dpt. and head nurse On-site teaching of Infection control Implementation of Infection control methods

25 deptt Identify The Case of HCV infection & Monitoring Desk Pt;s namet reporting Message sending Text to mobile phone

26 Reminding for patients

27 Reporting to CDC

28 Notes to Hospital Infection Control Office

29 Consulting 1. Consulting request 6. suggestion 7.evaluation) 2. Basic information 3. Message reminding 5. PDA check 4. Consulting confirm Page29

30 Full Duration Management of Hepatitis C Integrated model Traditional model Active monitor timing Waiting for patients Full duration manner Event management Simple referral efficiency Multi stage referral Manual report All patient included scope Partial Department, partial patients

31 Follow up & collaborative studies with Dr. ASF Lok

32 Peking University Hepatology Institute Hepatitis C Research - Predictors of Hepatitis C Progression Cross-sectional study Adults with chronic HCV infection, any stage of liver disease Two case-control study Cirrhosis vs. no cirrhosis HCC vs. no HCC Prospective cohort study Outcome: cirrhosis, HCC Parallel studies in China and US China: Peking University Health Science Center US: University of Michigan Health System

33 Peking University Hepatology Institute Specific Aims To identify genetic markers that predict progression from chronic HCV infection to cirrhosis and HCC To identify serum markers of liver fibrosis / cirrhosis To validate novel serum markers for early diagnosis of HCC To compare the results from the cohorts recruited at UMHS and at PUHSC Accuracy of genetic markers predictive of cirrhosis and HCC Accuracy of serum markers in predicting liver fibrosis Accuracy of serum markers in early diagnosis of HCC

34 Infrastructure Research team at each site Organizational structure, joint leadership, lines of reporting, communication plans, process for making decisions and for resolving conflicts Monthly web conference All documents in English and Chinese UMHS-PUHSC JOINT INSTITUTE

35 Standardization Two parallel cohorts of patients studied under same protocol One protocol same questionnaire One electronic database same case record forms One manual of operation bilingual, illustrated Standardized definition of outcomes Verified against source documents UMHS-PUHSC JOINT INSTITUTE

36 Key to Success in Cross-Culture Collaboration University-University initiate Serious commitment of both teams Mutual respect UMHS team bilingual and understands Chinese culture and medical practice in China Equal partners Frequent communications, monthly web conference reviews progress and problems Face to face meetings and mutual audits 1-2 times a year UMHS-PUHSC JOINT INSTITUTE

37 Peking University Hepatology Institute

38 Peking University Hepatology Institute Characteristics of patients at UMHS and PUHSC UMHS PUHSC P Values Total no Men (%) < Age (years, median, range) 57 (19-80) 53 (18-86) < BMI (median, range) 28.3 ( ) 24.5 ( ) < Year of infection (median, range) 1979 ( ) 1990 ( ) < Diabetes (%) < Alcohol (current/past, %) < Smoking (current/past, %) < Anti-HBc+ (%) < Rao HY, et al. EASL 2014, Poster 411

39 Peking University Hepatology Institute Characteristics of patients with no cirrhosis, cirrhosis, or HCC in China PUHSC No cirrhosis Cirrhosis HCC P Values Total no Men (%) < 0.01 Age (years, median) < 0.01 BMI (median) < 0.01 Year of infection (median) < 0.01 Diabetes (%) < 0.01 Alcohol (%) < 0.01 Smoking (%) < 0.01 Anti-HBc+ (%) < 0.01 Rao HY, et al. EASL 2014, Poster 411

40 Future of Hepatitis C research in China

41 Distribution of Hepatitis C Virus Genotypes by Country Wei L, Lok AS. Gastroenterology. 2014;146(5):

42 Distribution of HCV genotype in China Overall HCV Genotype 1b 1a 2b 2a or 2c 3b 3a 6c 6a or 6b Multiple genotypes Unidentifiable 42 Rao H, et al. J Gastroenterol Hepatol. 2014;29(3):

43 Distribution of IL-28B genotype Wei L, Lok AS. Gastroenterology. 2014;146(5):

44 What is difference of genetic background of patients between China and USA and impact for disease progression How to predict disease progression? How the treatment of Hepatitis C would reduce cancer development?

45 Acknowledgements Dr. Anna S. Lok Ms.Elizabeth Wu Dr. Andy Lin Dr. Chung Owyang Dr. Bo Feng Dr.Huiying Rao Dr. Ming Yang Dr. Fan Liu

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