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| ID | Type | Description | Link |
|---|---|---|---|
| R01DA057886 | U.S. NIH Grant/Contract | View source | |
| IRB202600334 | Registry Identifier | IRB |
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| Name | Class |
|---|---|
| National Institute on Drug Abuse (NIDA) | NIH |
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The goal of this observational study is to develop, implement, and evaluate a machine learning algorithm-based Hepatitis C Emergency Department (HepC-EnD) screening tool for use in emergency departments (EDs) to identify patients at high risk of hepatitis C virus (HCV) infection. HepC-EnD will be integrated into the University of Florida Health electronic health record (EHR) system as a best practice alert (BPA) pop-up for ED providers, notifying them of patients at high risk for HCV infection and recommending both HCV and human immunodeficiency virus (HIV) screening. Investigators aim to enhance the screening and diagnosis of individuals who may otherwise remain undiagnosed and untreated.
The implementation outcomes (e.g., usability) and effectiveness outcomes (e.g., HCV screening and diagnosis rates) of HepC-EnD targeted screening will be compared with universal screening (FOCUS) and conventional physician-initiated screening programs in EDs.
HCV infection has markedly increased in the United States, primarily resulting from injection drug use associated with the ongoing opioid epidemic. Despite the availability of highly effective direct-acting antiviral therapy, more than half of individuals with chronic HCV remain undiagnosed, leading to significant morbidity and mortality. EDs represent a critical setting for HCV and HIV screening, as they are currently the most common setting for missed diagnostic opportunities. However, universal ED-based screening programs are often costly and unsustainable. Moreover, existing targeted screening programs are limited, and have not been systematically developed or rigorously evaluated in clinical practice. Thus, there is a critical public health need to develop innovative, tailored, effective, and sustainable screening strategies to enhance HCV screening in EDs.
This study will accomplish three specific aims:
This study is guided by multiple implementation science frameworks, including the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, Proctor's Implementation Outcomes, and Five Rights, which will greatly increase the tool's utility, sustainability, and generalizability.
The investigators will conduct a quasi-experimental study to compare HepC-EnD to two existing screening strategies across three UF Health EDs over 12 months (6 months pre-implementation and 6 months post-implementation). UF Jacksonville Downtown ED will transition from universal screening (FOCUS) to HepC-EnD. UF Jacksonville North ED will continue FOCUS throughout the study period to serve as a control. UF Gainesville ED will pilot HepC-EnD, as FOCUS has not previously been implemented at that site. The study will evaluate the effectiveness of HepC-EnD's within-site and between-site comparisons.
The investigator's central hypothesis is that the use of HepC-EnD will have lower HCV and HIV screening rates but higher diagnosis rates and will be more cost-effective than universal screening and physician-initiated screening strategies.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| UF Jacksonville North ED | Patients presenting to UF Jacksonville North ED who opt-in for HCV screening during nurse triage. |
| |
| UF Jacksonville Downtown ED | Patients presenting to UF Jacksonville Downtown ED who opt-in for HCV screening during nurse triage (pre- and post-implementation). |
| |
| UF Gainesville ED | Patients presenting to UF Gainesville ED (pre-implementation) and patents presenting to UF Gainesville ED who opt-in for HCV during nurse triage (post-implementation). |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Physician-Initiated Screening (Conventional Screening) | Other | Screening for HCV and HIV in patients presenting to the ED occurs when an ED provider initiates screening based on symptoms or clinical judgement. Providers will manually order individual tests in the EHR. |
| Measure | Description | Time Frame |
|---|---|---|
| Proportion of new HCV or HIV diagnoses | Proportion of positive results among performed tests. HCV diagnosis is defined as a positive RNA test result. HIV diagnosis is defined as an acute (i.e., antigen positive but antibody negative) or established (i.e., antibody positive) infection. | Time Frame: 6 months pre- and post-implementation |
| Absolute number of new HCV or HIV diagnoses | Absolute number of positive results among performed tests. HCV diagnosis is defined as a positive RNA test result. HIV diagnosis is defined as an acute (i.e., antigen positive but antibody negative) or established (i.e., antibody positive) infection. | 6 months pre- and post-implementation |
| Measure | Description | Time Frame |
|---|---|---|
| Proportion of BPA alerts among individuals presenting to EDs | BPA alert for HepC-End or universal screening | 6 months pre- and post-implementation |
| Proportion of HCV and HIV tests performed among BPA alerts |
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Inclusion Criteria:
Exclusion Criteria:
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Patients visiting UF Health emergency departments.
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Haesuk Park, PhD | Contact | 352-273-6261 | hpark@cop.ufl.edu | |
| Khoa A Nguyen, PharmD | Contact | 352-273-9418 | nguyen.khoa@ufl.edu |
| Name | Affiliation | Role |
|---|---|---|
| Haesuk Park, PhD | University of Florida | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| UF Health Shands Emergency Room / Trauma Center | Gainesville | Florida | 32608 | United States | ||
| UF Health Jacksonville Emergency Room |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 40874186 | Background | Jang SC, Lo-Ciganic WH, Hernandez-Con P, Jenjai C, Huang J, Stultz A, Yan S, Wilson DL, Norse A, Guirgis FW, Cook RL, Gage C, Nguyen KA, Hornes P, Wu Y, Nelson DR, Park H. Development and Validation of a Machine Learning-Based Screening Algorithm to Predict High-Risk Hepatitis C Infection. Open Forum Infect Dis. 2025 Aug 15;12(8):ofaf496. doi: 10.1093/ofid/ofaf496. eCollection 2025 Aug. |
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| FOCUS (Universal Screening) | Other | During nurse triage, a FOCUS screening question will appear in the EHR and the patient will be asked to opt-in to HCV and HIV testing. For those who consented, if an ED provider enters a phlebotomy order for any reason in the EHR, a BPA will alert the providers to suggest HCV and HIV testing. The provider can decide to "order" or "do not order" for each test individually. Ordered tests automatically trigger the following in the EHR: HCV antibody with reflex to RNA and HIV 1/2 antigen/antibody with reflex to confirmation. For all patients who received positive test result in the ED, standardized linkage-to-care processes will be performed. These procedures are currently implemented in clinical practice. |
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| HepC-EnD (Targeted Screening) | Other | HepC-EnD will run in real time once integrated into the hospital's Epic EHR system. When the patient comes to the ED waiting room, a risk score generated from HepC-EnD will be available and determine if the patient is at high risk of HCV infection (> cutoff risk score). If the patient is determined to be at high risk, a HepC-EnD screening question will appear in the EHR during nurse triage and the patient will be asked will be asked to opt-in to HCV and HIV testing. For those who consented, a BPA will alert the ED provider to suggest HCV and HIV testing. The provider can decide to "order" or "do not order" for each test individually. Ordered tests automatically trigger the following in the EHR: HCV antibody with reflex to RNA and HIV 1/2 antigen/antibody with reflex to confirmation. For all patients who received positive test result in the ED, standardized linkage-to-care processes will be performed. |
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| 6 months pre- and post-implementation |
| Proportion of patients linked to care among those with positive HCV and HIV diagnoses | Linkage to care will be defined as a patient attending a first medical appointment within 3 months of receiving an HCV or HIV diagnosis. | 3 months after diagnosis |
| Composite HCV or HIV Diagnoses | All HCV and HIV diagnoses will be considered separately and will include both new and repeat diagnoses. | 6 months pre- and post-implementation |
| Jacksonville |
| Florida |
| 32209 |
| United States |
| UF Health North Emergency Room | Jacksonville | Florida | 32218 | United States |
| ID | Term |
|---|---|
| D006526 | Hepatitis C |
| D007239 | Infections |
| D000163 | Acquired Immunodeficiency Syndrome |
| D004630 | Emergencies |
| ID | Term |
|---|---|
| D000086982 | Blood-Borne Infections |
| D003141 | Communicable Diseases |
| D006525 | Hepatitis, Viral, Human |
| D014777 | Virus Diseases |
| D018178 | Flaviviridae Infections |
| D012327 | RNA Virus Infections |
| D006505 | Hepatitis |
| D008107 | Liver Diseases |
| D004066 | Digestive System Diseases |
| D015658 | HIV Infections |
| D015229 | Sexually Transmitted Diseases, Viral |
| D012749 | Sexually Transmitted Diseases |
| D016180 | Lentivirus Infections |
| D012192 | Retroviridae Infections |
| D012897 | Slow Virus Diseases |
| D000091662 | Genital Diseases |
| D000091642 | Urogenital Diseases |
| D007153 | Immunologic Deficiency Syndromes |
| D007154 | Immune System Diseases |
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| ID | Term |
|---|---|
| D059039 | Standard of Care |
| ID | Term |
|---|---|
| D019984 | Quality Indicators, Health Care |
| D011787 | Quality of Health Care |
| D006298 | Health Services Administration |
| D017530 | Health Care Quality, Access, and Evaluation |
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