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BACKGROUND/RATIONALE:
Liver biopsy is the most accurate way to assess liver damage resulting from chronic Hepatitis C infection. Both the VA and NIH recommend its use for managing most HCV patients and making treatment decisions for them. However, there may be significant variability in how medical treatments are used at different locations and over time. Less invasive techniques for assessing liver damage have emerged recently and they are almost as accurate as biopsy. Although less accurate, patient safety may be improved via alternative assessment strategies. In addition, some researchers and clinicians believe that if anitiviral treaments continue to improve, liver biopsy will not be needed at all in the near future. Other data suggest that liver biopsy may be especially useful in some patient subgroups and that biopsy can provide more information than is currently being utilized. In summary, there is considerable debate and possible uncertainty about how and when liver biopsy should be used, given its impact on patient safety.
OBJECTIVE(S):
Our objective is to identify patterns of liver biopsy use within the VA Healthcare System nationwide. In addition, we will examine predictors of liver biopsy use and identify characteristics of patients that do and do not get biopsied.
METHODS:
The study consists of analyzing data on all VA patients who have been entered into the VA Hepatitis C Case registry. The registry contains de-identified data on over 300,000 VA patients. We plan to clean, code, transform, and analyze data from all VA patients listed in the HCV Registry who have documented confirmatory viral testing. We will review all of the requested data fields in order to examine the consistency and quality of data. Of primary importance, is sorting out potential differences in the way liver biopsies have been recorded. Identified differences will be resolved in meetings with the PI, HCV clinicians, and other HCV researchers and data will be recoded into consistent variables by our data manager. We will examine patterns of liver biopsy use across the VA Healthcare System. We will examine co-morbid disorders from ICD-9 codes and Problem Lists. Demographics data and vital signs data will be examined. We will study serum hepatitis B antigen tests, HCV-RNA, HCV antibody tests, Genotype, liver function tests, complete blood count, and hepatitis A markers from the Lab Tests data table as possible predictor variables. The primary outcome variable will be confirmation of 1 or more liver biopsies. Hierarchical logistic regression analysis will be used to explore independent predictors of the primary outcome. We will provide odds ratios from the model with their 95% confidence intervals for independent predictors in the final mode
FINDINGS/RESULTS:
No results at this time.
IMPACT:
The proposed project will produce descriptive and statistical results about the recent use of liver biopsy in the national VA Healthcare system in caring for HCV-infected patients. Thus, the results may identify variability in the use of liver biopsy among VA regions or facilities and identify change over time. The results will inform VA health care policy and may directly result in policy changes that can improve the quality of healthcare for VA patients with HCV. The eventual benefit of this research to veterans may be more fully informed decision making, greater patient satisfaction with their VA healthcare, and indirectly, increased and possible more effective antiviral treatment of HCV in VA patients.
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases
DRE:
Diagnosis and Prognosis, Quality of Care
Keywords:
Practice patterns, Hepatitis C
MeSH Terms:
none
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