Stein Libby, Mittal Rasham, Song Hubert, Chung Joanie, Sahota Amandeep
Department of Internal Medicine, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA 90027, United States.
Department of Transplant Hepatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA 90027, United States.
World J Hepatol. 2023 Mar 27;15(3):419-430. doi: 10.4254/wjh.v15.i3.419.
Non-invasive tests, such as Fibrosis-4 index and transient elastography (commonly FibroScan), are utilized in clinical pathways to risk stratify and diagnose non-alcoholic fatty liver disease (NAFLD). In 2018, a clinical decision support tool (CDST) was implemented to guide primary care providers (PCPs) on use of FibroScan for NAFLD.
To analyze how this CDST impacted health care utilization and patient outcomes.
We performed a retrospective review of adults who had FibroScan for NAFLD indication from January 2015 to December 2017 (pre-CDST) or January 2018 to December 2020 (post-CDST). Outcomes included FibroScan result, laboratory tests, imaging studies, specialty referral, patient morbidity and mortality.
We identified 958 patients who had FibroScan, 115 before and 843 after the CDST was implemented. The percentage of FibroScans ordered by PCPs increased from 33% to 67.1%. The percentage of patients diagnosed with early F1 fibrosis, on a scale from F0 to F4, increased from 7.8% to 14.2%. Those diagnosed with advanced F4 fibrosis decreased from 28.7% to 16.5%. There were fewer laboratory tests, imaging studies and biopsy after the CDST was implemented. Though there were more specialty referrals placed after the CDST was implemented, multivariate analysis revealed that healthcare utilization aligned with fibrosis score, whereby patients with more advanced disease had more referrals. Very few patients were hospitalized or died.
This CDST empowered PCPs to diagnose and manage patients with NAFLD with appropriate allocation of care towards patients with more advanced disease.
非侵入性检测，如纤维化-4指数和瞬时弹性成像（通常为FibroScan），被用于临床路径中对非酒精性脂肪性肝病（NAFLD）进行风险分层和诊断。2018年，实施了一项临床决策支持工具（CDST），以指导初级保健提供者（PCP）使用FibroScan诊断NAFLD。
分析该CDST如何影响医疗保健利用和患者结局。
我们对2015年1月至2017年12月（CDST实施前）或2018年1月至2020年12月（CDST实施后）因NAFLD指征接受FibroScan检查的成年人进行了回顾性研究。结局包括FibroScan结果、实验室检查、影像学检查、专科转诊、患者发病率和死亡率。
我们确定了958例接受FibroScan检查的患者，CDST实施前115例，实施后843例。初级保健提供者开具FibroScan检查的比例从33%增加到67.1%。在F0至F4分级中，被诊断为早期F1纤维化的患者比例从7.8%增加到14.2%。被诊断为晚期F4纤维化的患者比例从28.7%降至16.5%。CDST实施后，实验室检查、影像学检查和活检减少。虽然CDST实施后专科转诊增多，但多变量分析显示，医疗保健利用与纤维化评分一致，即疾病进展较严重的患者转诊更多。很少有患者住院或死亡。
该CDST使初级保健提供者能够诊断和管理NAFLD患者，并对疾病进展较严重的患者进行适当的护理分配。
