Author:
Kumar Sonal,Mohanty Arpan,Mantry Parvez,Schwartz Robert E.,Haff Madeleine,Therapondos George,Noureddin Mazen,Dieterich Douglas,Girgrah Nigel,Cohn Kristi,Savanth Mohanish,Fuchs Michael
Abstract
Abstract
Background
Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly referred to as nonalcoholic fatty liver disease, impacts 30% of the global population. This educational pilot focused on the role primary care providers may play in the delivery of guidelines-based metabolic dysfunction-associated steatohepatitis (MASH) care.
Objective
Accelerate the application of guidelines-based MASH care pathways to clinical workflows.
Methods
A panel of six hepatologists was convened in 2021 to develop the care pathway and the subsequent pilot occurred between 2022 – 2023. The pilot was conducted across three U.S. health systems: Boston Medical Center (Boston), Methodist Health System (Dallas), and Weill Cornell Medicine (New York). Clinicians were educated on the care pathway and completed baseline/follow-up assessments. 19 primary care clinicians participated in the educational pilot baseline assessment, nine primary care clinicians completed the two-month assessment, and 15 primary care clinicians completed the four-month assessment. The primary endpoint was to assess clinician-reported adherence to and satisfaction with the care pathway. The pilot was deemed exempt by the Western Consensus Group Institutional Review Board.
Results
At baseline, 38.10% (n = 8) of respondents felt they had received sufficient training on when to refer a patient suspected of metabolic dysfunction-associated liver disease to hepatology, and 42.86% (n = 9) had not referred any patients suspected of metabolic dysfunction-associated liver disease to hepatology within a month. At four months post-intervention, 79% (n = 15) of respondents agreed or strongly agreed they received sufficient training on when to refer a patient suspected of metabolic dysfunction-associated liver disease to hepatology, and there was a 25.7% increase in self-reported adherence to the institution’s referral guidelines. Barriers to care pathway adherence included burden of manually calculating fibrosis-4 scores and difficulty ordering non-invasive diagnostics.
Conclusions
With therapeutics anticipated to enter the market this year, health systems leadership must consider opportunities to streamline the identification, referral, and management of patients with metabolic dysfunction-associated steatohepatitis. Electronic integration of metabolic dysfunction-associated steatohepatitis care pathways may address implementation challenges.
Publisher
Springer Science and Business Media LLC
Reference18 articles.
1. Fernando DH, Forbes JM, Angus PW, Herath CB. Development and progression of non-alcoholic fatty liver disease: the role of advanced glycation end products. Int J Mol Sci. 2019;20(20): 5037. https://doi.org/10.3390/ijms20205037.
2. Rinella ME, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Ann Hepatol. 2024;29(1): 101133. https://doi.org/10.1016/j.aohep.2023.101133.
3. American Liver Foundation. Nash definition & prevalence. 2022. https://liverfoundation.org/liver-diseases/fatty-liver-disease/nonalcoholic-steatohepatitis-nash/nash-definition-prevalence/#:~:text=NAFLD%20is%20the%20most%20common,of%20adults%20in%20the%20U.S
4. American liver foundation. Nonalcoholic fatty liver disease (NAFLD). 2023. https://liverfoundation.org/liver-disease.
5. Glass LM, Hunt CM, Fuchs M, Su GL. Comorbidities and nonalcoholic fatty liver disease: the chicken, the egg, or both? Federal practitioner: for the health care professionals of the VA, DoD, and PHS. 2019;36(2):64–71.