Hepatitis C-Related Admissions to a Public Health Hospital and Hepatitis C Reporting to the Massachusetts Department of Public Health

BACKGROUND:  The aims of this study were to evaluate completeness of reporting of positive hepatitis C virus (HCV) antibody results on patients hospitalized at a public health hospital with an ICD-9 diagnosis code for HCV infection, to assess whether reporting improved over time, and to evaluate HCV nucleic acid test (HCV RNA) performance and reporting. 

METHODS:  The Lemuel Shattuck Hospital (LSH) is long-term acute and chronic care hospital operated by the Massachusetts Department of Public Health (MDPH) and serving patients admitted from the community and correctional facilities. HCV infection surveillance data from 1992 through 2012 were extracted from the MDPH electronic surveillance system, MAVEN, and matched to LSH patients discharged with ICD-9 codes for HCV infection in 2004, 2008, and 2011. Only the latest admission per patient was included in the analysis. A total of 102,589 HCV case reports from MAVEN were matched against 811 HCV patients from LSH based on first name, last name, and date of birth using SAS 9.3 software. Patients with laboratory results without a specimen date, test type, or result value in MAVEN were excluded from the analysis. MAVEN was queried for HCV antibody (HCV ab), HCV RNA, or HCV genotype laboratory tests.  HCV RNA and HCV genotype tests were both classified as a nucleic acid amplification test, or NAAT.

RESULTS:  There were 811 patients discharged from LSH in 2004, 2008, and 2011 with ICD-9 diagnostic code for HCV infection.  Six-hundred and twelve (75%) patients were reported to MDPH and captured in MAVEN with either a positive HCV Ab or NAAT test. Sixty-three percent (n=383) were reported with both an HCV Ab and positive NAAT test. Twenty-one percent (n=229) had only a positive HCV Ab test reported and 17% (n=103) had only a positive NAAT test reported. Reporting to MDPH improved over time; 67% in 2004 and 81% in 2011.

CONCLUSIONS:  Reporting of patients with evidence of HCV infection improved between 2004 and 2011.  However, under-reporting of HCV infection even from a public health hospital remains a problem, with 19% of patients with an ICD-9 code for HCV infection in 2011 not being reported to MDPH. The next phase of analysis will expand the time frame and outcomes. Twenty-one percent of the LSH patients who were reported to MDPH with only an HCV ab test captured. Efforts are needed to improve completeness of reporting and to ensure that patients receive additional testing and follow-up care for their HCV infection.