P4099 - A Quality Improvement Project to Screen, Risk Stratify, and Manage Patients With Nonalcoholic Fatty Liver Disease

Pratishtha Singh, MD, Makda Bsrat, MD, Sarah Huang, MD, Anas Zaher, MD, Zhongqian Lin, MD, Ilan Weisberg, MD
New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY

Introduction: Nonalcoholic fatty liver disease (NAFLD) affects 37% of US adults with prevalence rising exponentially in concert with the global epidemic of obesity and metabolic disorders. It has become the leading cause of end-stage liver disease and referral for liver transplant. In 2021, the American Gastroenterological Association (AGA) developed a clinical care pathway to provide explicit guidance on the screening, diagnosis and treatment of NAFLD. Despite this, a majority of patients with the highest risk of progression to end stage liver disease remain underappreciated. This ongoing quality improvement project aims to raise awareness in screening and risk stratification while prioritizing linkage of patients with advanced fibrosis to hepatology care.

Case Description/Methods: The pathway was implemented at New York Presbyterian Brooklyn Methodist Hospital beginning in February 2023. Education was provided to all providers and a standard EMR based screening tool was implemented. Patients at risk for clinically significant fibrosis were identified and categorized as low, medium, or high risk to guide management. Further management was directed as listed in the figure.

Discussion: 478 patients were screened for NAFLD, showing a 15% increase compared to data from 4 months prior to project initiation. Among those screened, 67.8% were low risk and continued on lifestyle modifications, 18.8% were eligible for elastography, and 3.57% were referred to hepatology. This project shows an improvement in screening and priority referral for those with advanced fibrosis. A challenge during the implementation phase was continuous engagement from providers. This was addressed by regular feedback/educational meetings, and use of visual aids. A small sample size remains a limitation of our project, which may over or underestimate the prevalence of advanced fibrosis. This is expected to improve with continued project implementation. This project highlights the importance of integrating AGA’s clinical pathway into routine clinical practice, as intervention in earlier stages of NAFLD is associated with reduced health costs to the patient and healthcare system. Brooklyn represents one of the most ethnically and racially diverse communities within New York City, and a secondary intention of this project is to address healthcare disparities that are known to exist in the spectrum of NAFLD. Future investigations will focus on effects of guideline adherence on patient outcomes.



Disclosures:


Pratishtha Singh, MD, Makda Bsrat, MD, Sarah Huang, MD, Anas Zaher, MD, Zhongqian Lin, MD, Ilan Weisberg, MD. P4099 - A Quality Improvement Project to Screen, Risk Stratify, and Manage Patients With Nonalcoholic Fatty Liver Disease, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.