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Cs the Day
Hepatitis C Treatment During Hospitalization
HCV is curable with just a few months of antiviral treatment, but many patients face barriers to accessing outpatient treatment. Hospitalization offers an opportunity to overcome these barriers by bringing treatment directly to inpatients.
Cs the Day is a quality improvement initiative at NYP–Weill Cornell and NYP–Lower Manhattan Hospital that integrates inpatient HCV assessment and counseling, DAA prescribing and treatment initiation, bedside medication delivery, and low-barrier follow-up for selected patients. See details of our intervention and our results below.
Supported by a grant from the NewYork-Presbyterian Dalio Center for Health Justice.
Tracking Improvement over Time
Understanding QI Charts
Quality improvement (QI) uses data collected over time to evaluate how well a program is working and identify opportunities for improvement. For Cs the Day, we track hepatitis C (HCV) treatment assessment, prescribing, initiation, and completion.
Run charts show how a measure changes over time, with a horizontal line representing the median. Our prescribing run chart shows the percentage of eligible hospital encounters resulting in a direct-acting antiviral (DAA) prescription each month. The baseline median is 0% because most months had no prescriptions. This reflects low baseline treatment rates.
Shewhart charts (control charts) also track performance over time but include statistical control limits to help distinguish expected variation from potentially meaningful changes.
- Assessment: Our assessment chart tracks the proportion of eligible encounters assessed by the HCV team. The center line represents the overall assessment rate (68/87, 78.2%).
- Treatment: Three additional charts track DAA prescribing, initiation, and documented completion. Their center lines reflect baseline rates of 8.1% (3/37), 8.1% (3/37), and 5.4% (2/37), respectively, allowing comparison across the baseline and intervention periods.
Because these baseline rates are based on very few events, the treatment charts should be considered exploratory.
Control limits and the 3-sigma rule
Control limits are statistical boundaries used to distinguish expected variation from potentially meaningful changes in a process. They are typically set three standard deviations (3 sigma) above and below the center line. A point outside these limits suggests that the process may have changed and warrants further investigation. Control limits are wider when fewer encounters contribute to a month, reflecting greater uncertainty. With our small monthly sample sizes, these limits should be interpreted cautiously.
How to interpret our charts: Each point represents patients grouped by their hospital admission month. Gaps indicate months with no eligible encounters, rather than months with 0% performance. Orange diamonds identify pilot patients; the baseline and intervention periods overlap in calendar time because the intervention started at different times at the two hospitals. Because monthly sample sizes are small and follow-up is incomplete for some patients, these charts should be interpreted cautiously. Points falling within control limits do not necessarily indicate that the process is stable.
