Study population
liver cancer, cirrhosis, fibrosis, HCC
LIVER CANCER, CIRRHOSIS, FIBROSIS, METASTATIC CANCER, DISEASE
From our electronic health record (EHR), we identified all patients who were 18 years or older with a current diagnosis of cirrhosis or advanced fibrosis (as defined by the clinician in the EHR), were followed by gastroenterology or hepatology (with one or more visit to any gastroenterology or hepatology practice in the preceding 2 years) and who lived in the Philadelphia Metropolitan Statistical Area. For initial automated extraction, we used International Classification of Disease (ICD-10) codes (K74.60, K74.69, K70.31, K70.30) or cirrhosis in the active problem list of the EHR or in encounter diagnoses in the previous 3 years. Patients were excluded if they had completed liver cancer surveillance within the past 7 months, had a surveillance imaging test scheduled, or a different imaging modality (MRI or CT) recommended by their physician. Patients were also excluded if they had a history of HCC or other liver cancer diagnosis, history of liver transplant, metastatic cancer, or were receiving hospice care. Similarly, ICD-10 codes and the problem list were used for automated data extraction, complemented by manual chart review.Once patients were confirmed as eligible through a manual medical record review, the gastroenterology/hepatology providers were sent a message with a list of their eligible patients through the EHR and given the opportunity to opt their patients out of participation. If a provider chose to opt-out a patient, the patient was excluded from randomization.