Background: Globally, hepatocellular carcinoma (HCC) is the third leading cause of cancer‐related death and the second of cancer‐related years of life lost. Regular screening of asymptomatic patients at risk for HCC may detect tumors at an early stage when potentially curative treatment can be offered. 2018 guidelines by the American Association for the Study of Liver Diseases (AASLD) recommend that patients with cirrhosis undergo surveillance with ultrasound (US) of the liver every 6 months with or without alpha fetoprotein (AFP). In our rural primary care practice in Southwestern Indiana, we identified 31 patients with cirrhosis. Of those, 14 (45%) lacked up-to-date screening, and 10 (32%) had suboptimal surveillance (7 to 15 months and beyond). While our screening adherence of 55% was slightly above the national average of 52% obtained from a meta-analysis in 2018, our overall screening trend adherence over the past 2 years has been suboptimal based on a retrospective study in 2017. To improve the long-term screening adherence, we created a Quality Improvement (QI) tool to remind physicians of upcoming screenings due.
Methods: A data set for patients with a potential diagnosis of cirrhosis (ICD-10 codes K70, K70.2, K70.3, K70.31, K70.30, K71.7, K74, K74.6, K74, K74.6, K74.60, K74.69, K76.1, K76, K76.9) was pulled from our clinic between 7/1/2021 and 9/1/2023. Our search yielded 31 patients with cirrhosis who were evaluated for up-to-date screenings. Of those, 14 (45%) were found to lack up-to-date screening with liver US (CPT codes 76705 and 76700), and 10 (32%) had suboptimal surveillance (screening every 7-26 months). To improve the screening adherence trend in the short term, the physician with a patient devoid of an up-to-date US in the prior 6 months received an “Alert message” via the chat function of our electronic health record to schedule an US. In the longer term, to improve continued screening adherence, each physician will continue to receive an “Alert message” on a bi-annual basis based on their patient’s last screening date.
Results: Our team was able to reach all physicians with patients lacking up-to-date screening via chat function 2 weeks ago. Thus far, 2 of the 14 patients (14.3%) completed their US and are now up to date with screening.
Conclusions: Regular screening for HCC in cirrhosis leads to early detection and can potentially be lifesaving. However, it must be performed every 6 months to be effective. While suboptimal screening is better than nonexistent screening, it can lead to delayed diagnosis and treatment. To improve patient outcomes and reduce mortality, we created a QI tool to improve our screening adherence trend. At this time, results are still in progress, and we will periodically reassess for US completion until the 4-week mark from the initial “Alert message”. In the meantime, we will continue to send alerts to physicians whose patient is due for screening based on their last US date.