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Highlights

In 1998, the Department of Veterans Affairs (VA) launched an initiative to screen and test veterans for hepatitis C--a chronic blood-borne virus that can cause potentially fatal liver-related conditions. Since 2001, GAO has been monitoring VA's hepatitis C program. This year GAO was asked to report on VA's hepatitis C disease management practices. GAO surveyed 141 VA medical facilities about their processes for notifying veterans concerning hepatitis C test results and evaluating veterans' medical conditions regarding potential treatment options. In addition, GAO reviewed medical records of 100 hepatitis C patients at 1 facility and visited 4 other facilities that used unique hepatitis C disease management processes.

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Recommendations

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Veterans Affairs 1. To continue to improve the management of hepatitis C, the Secretary of Veterans Affairs should direct the Under Secretary for Health to direct facilities to use special arrangements, such as mail or telephone when appropriate, to notify a veteran rather than waiting until the next regularly scheduled visit if it is more than 30 days away.
Closed - Not Implemented
Although VA has not directed facilities to use special arrangements to notify veterans, it has given facilities guidance (IL 10-2002-019) for notifying veterans of hepatitis C test results. The guidance includes designating one individual in the facility to be responsible for receiving test results and subsequently notifying the veterans. VA has also implemented an electronic system--HealtheVet--that permits veterans to obtain test results, among other information, via the computer. VA's hepatitis C Case Registry has been implemented and includes an enhancement that permits facilities to identify and track veterans who need to be notified of test results.
Department of Veterans Affairs 2. To continue to improve the management of hepatitis C, the Secretary of Veterans Affairs should direct the Under Secretary for Health to direct facilities to modify their computerized patient record systems so that providers are alerted to positive hepatitis C test results as soon as possible.
Closed - Not Implemented
This recommendation is being closed without being implemented because VA states that it has given sufficient guidance on testing and notification to its facilities. VA issued guidance in the form of an Information Letter (IL 10-2002-019) and facility clinicians are notified promptly of hepatitis C test results through use of the view/alert in the electronic medical record or the critical value alert from the laboratory. VA is reluctant to use the critical value alert to immediately notify clinicians because hepatitis C test results are not thought to be critical. VA believes that any changes to its electronic medical record system would not be cost effective without national level data indicating problems with hepatitis C result notification.
Department of Veterans Affairs 3. To continue to improve the management of hepatitis C, the Secretary of Veterans Affairs should direct the Under Secretary for Health to help facilities improve the timeliness of evaluations for veterans diagnosed with hepatitis C by encouraging facilities to use nonspecialists to conduct initial evaluations, and develop clinical guidelines for when to refer veterans to physician specialists for additional consultations.
Closed - Implemented
VA has provided medical facilities with tools to improve timeliness of evaluations for veterans diagnosed with hepatitis C. These tools are educational activities for clinicians that include: (1) distribution of a pocket reference and training materials concerning evaluation of hepatitis C veterans, specifically targeted to non-specialists; (2) an update of VA's hepatitis C treatment recommendations to reflect current knowledge and latest drug approval information; (3) three satellite TV broadcasts that address evaluation and care of veterans with hepatitis C; (4) web-based learning tools developed and available by end of calendar year 2003; (5) development of a hepatitis C template for clinicians' documentation of treatment; and (6) restructuring of a preceptorship program to broaden the scope of hepatitis C training and encourage collaborative care between clinicians. Data on timeliness of evaluation and assessment of candidacy for antiviral therapy are being collected through the External Peer Review Program to further guide development of performance improvement initiatives.

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