Clinical decision support automates care gap detection among primary care patients with nonalcoholic fatty liver disease

• Published in: Hepatology communications Vol. 7; no. 3; p. e0035
• Main Authors: Spann, Ashley, Bishop, Kristy M, Weitkamp, Asli O, Stenner, Shane P, Nelson, Scott D, Izzy, Manhal
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01.03.2023; Wolters Kluwer Health/LWW
• Subjects: Decision Support Systems, Clinical; Elasticity Imaging Techniques; Humans; Liver Cirrhosis - diagnosis; Non-alcoholic Fatty Liver Disease - diagnosis; Non-alcoholic Fatty Liver Disease - epidemiology; Non-alcoholic Fatty Liver Disease - therapy; Primary Health Care; Research Letter
• ISSN: 2471-254X; 2471-254X
• DOI: 10.1097/HC9.0000000000000035

Although guidelines recommend primary care-driven management of NAFLD, workflow constraints hinder feasibility. Leveraging electronic health records to risk stratify patients proposes a scalable, workflow-integrated strategy. We prospectively evaluated an electronic health record-embedded clinical decision support system's ability to risk stratify patients with NAFLD and detect gaps in care. Patients missing annual laboratory testing to calculate Fibrosis-4 Score (FIB-4) or those missing necessary linkage to further care were considered to have a gap in care. Linkage to care was defined as either referral for elastography-based testing or for consultation in hepatology clinic depending on clinical and biochemical characteristics. Patients with NAFLD often lacked annual screening labs within primary care settings (1129/2154; 52%). Linkage to care was low in all categories, with <3% of patients with abnormal FIB-4 undergoing further evaluation. Significant care gaps exist within primary care for screening and risk stratification of patients with NAFLD and can be efficiently addressed using electronic health record functionality.