Stein L, Mittal R, Song H, Chung J, Sahota A. To scan or not to scan: Use of transient elastography in an integrated health system. World J Hepatol 2023; 15(3): 419-430 [PMID: 37034236 DOI: 10.4254/wjh.v15.i3.419]
Corresponding Author of This Article
Libby Stein, MD, Doctor, Department of Internal Medicine, Kaiser Permanente Los Angeles Medical Center, 4867 Sunset Blvd, Los Angeles, CA 90027, United States. libby.x.stein@kp.org
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Libby Stein, Department of Internal Medicine, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA 90027, United States
Rasham Mittal, Amandeep Sahota, Department of Transplant Hepatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA 90027, United States
Hubert Song, Joanie Chung, Research and Evaluation, Kaiser Permanente Southern California, Los Angeles, CA 91101, United States
Author contributions: Stein L, Mittal R and Sahota A designed the study; Song H and Chung J gathered the data and performed the statistical analysis; Stein L wrote the manuscript; all authors read, edited and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Kaiser Permanente Southern California Institutional Review Board (Approval No. #12674).
Informed consent statement: Because of the nature of a retrospective study, signed informed consent form is not needed. However, Kaiser Permanente Los Angeles Medical Center has given permission to conduct this study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Libby Stein, MD, Doctor, Department of Internal Medicine, Kaiser Permanente Los Angeles Medical Center, 4867 Sunset Blvd, Los Angeles, CA 90027, United States. libby.x.stein@kp.org
Received: October 21, 2022 Peer-review started: October 21, 2022 First decision: December 23, 2022 Revised: January 6, 2023 Accepted: March 1, 2023 Article in press: March 1, 2023 Published online: March 27, 2023
ARTICLE HIGHLIGHTS
Research background
Non-alcoholic fatty liver disease (NAFLD) is a growing problem, affecting over 25% of the global population. Non-invasive tests are being used more and more to risk stratify and diagnose patients with NAFLD. However, there is a paucity of data for how these tests are being used for clinical decision making in real-world practice.
Research motivation
We examined a clinical decision support tool (CDST) designed to guide primary care providers (PCPs) in the care of patients with NAFLD.
Research objectives
To evaluate health care utilization, practice patterns and patient outcomes of patients who underwent FibroScan for NAFLD indication.
Research methods
A retrospective review of 958 adult patients who underwent FibroScan. Patients were compared before and after introduction of the CDST. Univariate and multivariate logistic regression models were performed in statistical analyses.
Research results
Introduction of the CDST allowed for more patients with early fibrosis and fewer patients with advanced fibrosis to be identified. Overall, fewer labs, imaging studies and biopsies were ordered after the CDST. Providers appropriately ordered more specialty referrals for patients with more advanced fibrosis.
Research conclusions
This CDST empowered PCPs to diagnose and manage patients with NAFLD with appropriate allocation of care towards patients with more advanced disease.
Research perspectives
Non-alcoholic fatty liver disease can feasibly be diagnosed and managed in the primary care setting. Future research is required to streamline and refine care of this patient population.
