Assessing Clinician Engagement With a Passive Clinical Decision Support System for Liver Fibrosis Risk Stratification in a Weight Management Clinic
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View abstract on PubMed
Summary
This summary is machine-generated.Implementing a 3-strategy bundle to improve liver fibrosis risk stratification for metabolic dysfunction-associated steatotic liver disease (MASLD) in obesity did not significantly increase patient referrals. Electronic health record (EHR) decision support shows potential but needs better integration.
Area Of Science
- Hepatology
- Implementation Science
- Digital Health
Background
- Metabolic dysfunction-associated steatotic liver disease (MASLD) is prevalent in obesity.
- Current guidelines recommend fibrosis risk stratification using tools like the Fibrosis-4 (FIB-4) index and vibration-controlled transient elastography (VCTE).
- Limited implementation of these guidelines necessitates novel strategies.
Purpose Of The Study
- To evaluate a 3-strategy implementation bundle aimed at enhancing fibrosis risk stratification for MASLD.
- Strategies included an EHR-embedded clinical decision support system (CDSS), educational outreach, and internal facilitation.
- The study focused on a weight management clinic setting.
Main Methods
- A mixed-methods approach was employed.
- The primary outcome measured was the proportion of patients with elevated FIB-4 scores who completed VCTE or received a hepatology referral.
- Fischer's exact test compared pre- and post-implementation rates, with semi-structured interviews assessing provider perceptions.
Main Results
- Automated FIB-4 score calculation increased from 22.4% to 54.2% of visits post-implementation.
- Despite increased FIB-4 scores, VCTE and hepatology referrals remained low (0 and 2 pre-implementation vs. 3 and 2 post-implementation).
- Providers identified barriers including shared responsibility, low trust in tools, and workflow challenges.
Conclusions
- The tested implementation bundle did not significantly improve MASLD fibrosis risk stratification.
- EHR-based CDSS shows promise but requires better alignment with provider priorities and workflow.
- Robust technical infrastructure and seamless integration are crucial for successful implementation.
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