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To scan or not to scan:Use of transient elastography in an integrated health system

World Journal of Hepatology 2023年第3期15卷 419-430页

作者： libby stein Rasham Mittal Hubert Song Joanie Chung Amandeep Sahota Department of Internal Medicine Kaiser Permanente Los Angeles Medical CenterLos AngelesCA 90027United States Department of Transplant Hepatology Kaiser Permanente Los Angeles Medical CenterLos AngelesCA 90027United States Research and Evaluation Kaiser Permanente Southern CaliforniaLos AngelesCA 91101United States

BACKGROUND Non-invasive tests,such as Fibrosis-4 index and transient elastography(com-monly 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 *** To analyze how this CDST impacted health care utilization and patient *** 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 *** We identified 958 patients who had FibroScan,115 before and 843 after the CDST was *** 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 ad-vanced F4 fibrosis decreased from 28.7%to 16.5%.There were fewer laboratory tests,imaging studies and biopsy after the CDST was *** 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 *** few patients were hospitalized or *** This CDST empowered PCPs to diagnose and manage patients with NAFLD with appropriate allocation of care towards patients with more advanced disease.

关键词： Non-alcoholic fatty liver disease Transient elastography FibroScan Clinical decision support tool Health care utilization Primary care

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