PONE-D-22-18564HCV Universal EHR Prompt Successfully Increases Screening, Highlights Potential DisparitiesPLOS ONE

Dear Dr. Hack,

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Reviewer #1: Yes

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Reviewer #1: Yes

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Reviewer #1: Yes

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Reviewer #1: Yes

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5. Review Comments to the Author

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Reviewer #1: In the paper, Hack and colleagues present an analysis of HCV screening practices before and after initiation of a BPA in an academic health system. They report that screening rates went up after the BPA was implemented and screening improved in adult groups who were the focus on new universal screening recommendations. The results are straightforward and support the use of a BPA to increase screening. I think the paper would benefit from some added information and discussion to help readers put these results into the proper context.

First, the readers needs more information about the health system mentioned. All outpatient visits are not the same, so some broad breakdown of visits for primary care, specialty care or ED would be helpful. This is also germane to the subgroups the authors mention with disparities, as some specialty physicians may not take ownership of screening when they see this as the purview of the primary care physicians. Also, a general breakdown of patients seen within the system (race, ethnicity, insurance breakdown) would be helpful to better understand how the screened population differs from all patients seen.

Second, there is no discussion of what education and/or preparation was provided prior to initiation. Were providers given a primer as to the policy changes that led to the BPA? Some physicians are very aware while others may be oblivious. We need more information to help understand the impact of these changes.

The authors state that more women were screened. Given that universal screening in pregnancy was a key inclusion in both public health recommendations, with the CDC recommending screening with every pregnancy, this is expected. The authors neglect to mention this subgroup in their results and it is a significant omission. Some additional discussion of pregnancy screening needs to be included.

The paper would benefit from some discussion about how the authors are planning to improve the use and function of the BPA. Aside from drawing attention to the disparate practices in screening different groups, how do we get to 100%?

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Reviewer #1: No

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HCV Universal EHR Prompt Successfully Increases Screening, Highlights Potential Disparities

PONE-D-22-18564R1

Dear Dr. Anzalone,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Kimberly Page, PhD, MPH

Academic Editor

PLOS ONE

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