Improving Referral for Hepatitis C Testing in Kittitas County


Impact Statement: 
Kittitas County Health Department improved their process for Alcohol Drug Dependency Service (ADDS) clients to follow through with Hepatitis C testing so that treatment would be received earlier and the spread of the disease reduced.

Kittitas County Public Health Department (KCPHD) initiated the quality improvement (QI) process in response to marked reduction in referrals for hepatitis C testing and counseling from 2010 to 2011. In 2010, much of the hepatitis C testing was done at the jail, where there was a concentrated high-risk population. But in 2011, KCPHD was no longer allowed to offer testing at the jail, so it wanted to increase referrals from other sources. First, a baseline evaluation was completed to determine which referral partners to include in the process. The primary local drug and alcohol evaluation and treatment program (Alcohol Drug Dependency Services [ADDS]) was chosen because it has a steady stream of high-risk clients who are good candidates for testing. No other agencies in the community serve as many appropriate candidates for testing. ADDS was approached and found willing to collaborate. The root causes of reduced referrals were identified using brainstorming sessions, interviews, and surveys of ADDS staff and clients. An affinity diagram was developed to classify barriers to hepatitis C testing. The aim statement was developed, including a specific date when the number of clients referred for testing should increase and the hoped-for level of increase. Process maps were developed to better understand the current processes and where opportunities might exist for improvement. As a result, ADDS staff decided to change the point of referral in their evaluation and treatment process from the beginning to the end. KCPHD’s outreach worker also provided two group training sessions to the ADDS staff about hepatitis C and what testing and counseling involve. The staff took pre- and post-surveys to help determine effectiveness of the presentations. Along with an increase in the number of successful referrals, we have seen an increase in respect and collaboration between our public health and ADDS staff.

Organization that conducted the QI initiative: 

Whitaker, L. Public Health Quality Improvement Exchange. Improving Referral for Hepatitis C Testing in Kittitas County. Mon, 02/27/2017 - 14:10. Available at Accessed May 23, 2024.

Submission Status: 
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Submitted by lkent on

Kudos for your work on this QI project and for thinking ahead about the need to effectively plan and deal with changes in personnel as you move through your next QI initiative. Too many times we find ourselves having to deal with major changes halfway through projects, only to find that we're unprepared to keep the ball moving forward. Keep up the good work!

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