Degree Name

Doctor of Nursing Practice (DNP)

Document Type

Limited Access


Zvart Onanian School of Nursing




Background: Hepatocellular carcinoma (HCC) is one of the leading causes of death among patients with Advanced Liver Disease (ALD). Patients with ALD have approximately 2-4% yearly risk of developing HCC. The 2018 American Association for the Study of Liver Diseases (AASLD) recommends surveillance using ultrasound (US), with or without alpha fetal protein (AFP) measurement every 6 months. Studies show low HCC surveillance rates of about 20% among people with ALD. In a study, 88% of HCVinfected Veterans with ALD within the VA health care system did not receive routine HCC surveillance as recommended by national guidelines. Purpose/Specific Aims: The purpose of this scholarly project is to increase HCC screening rates in patients with ALD at Providence Veterans Affairs Medical Center (PVAMC) by developing effective multidisciplinary ALD screening program. Specific aims are to examine how multidisciplinary interventions can improve team’s compliance with national HCC guidelines, measured by increase HCC screening rates among patients with ALD. Methods: Univariate descriptive design was used for this quality improvement project. The sample included veterans with diagnosis of ALD. The project was conducted at an outpatient hepatology clinic at PVAMC. The intervention included offering same day walk-in ultrasound for veterans with ALD. Baseline data on the rates of screening abdominal ultrasounds were collected, and post-intervention data was collected for five months. Differences between pre and post intervention data were analyzed using chi square. Results: This project resulted in increased HCC ultrasound screening rates among ALD patients, and an increase in provider’s compliance with national HCC screening guidelines. Conclusion: AASLD guidelines recommends every 6 months screening ultrasounds for HCC surveillance in patients with ALD. At PVAMC, providing veterans with same day walk-in ultrasounds to coincide with their liver clinic appointment eliminated a number of barriers to HCC screening, and lead to increase in compliance.


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