背景:代谢功能障碍相关的脂肪变性肝病(MASLD),以前被称为非酒精性脂肪性肝病,影响了全球30%的人口。该教育试点侧重于初级保健提供者在提供基于指南的代谢功能障碍相关脂肪性肝炎(MASH)护理中可能发挥的作用。
目的:加快基于指南的MASH护理路径在临床工作流程中的应用。
方法:2021年召集了由六名肝病学家组成的小组,以开发护理途径,随后的试点于2022年至2023年之间进行。试点是在三个美国卫生系统进行的:波士顿医疗中心(波士顿),卫理公会卫生系统(达拉斯),和威尔康奈尔医学(纽约)。对临床医生进行了有关护理途径的教育,并完成了基线/随访评估。19名初级保健临床医生参加了教育试点基线评估,九名初级保健临床医生完成了为期两个月的评估,15名初级保健临床医生完成了为期4个月的评估.主要终点是评估临床医生报告的对护理途径的依从性和满意度。该试点被西方共识集团机构审查委员会视为豁免。
结果:在基线时,38.10%(n=8)的受访者认为他们已经接受了足够的培训,何时将怀疑代谢功能障碍相关肝病的患者转诊到肝病学。42.86%(n=9)的患者在1个月内没有将任何疑似代谢功能障碍相关肝病的患者转诊至肝病科.干预后四个月,79%(n=15)的受访者同意或强烈同意他们接受了足够的培训,何时将怀疑代谢功能障碍相关肝病的患者转诊到肝病学。自我报告对该机构转诊指南的依从性增加了25.7%。护理途径依从性的障碍包括手动计算纤维化-4评分的负担和难以订购非侵入性诊断。
结论:预计今年将进入市场的疗法,卫生系统领导层必须考虑简化识别的机会,转介,与代谢功能障碍相关的脂肪性肝炎患者的管理。代谢功能障碍相关的脂肪性肝炎护理途径的电子整合可以解决实施挑战。
BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly referred to as nonalcoholic fatty liver disease, impacts 30% of the global population. This educational pilot focused on the role primary care providers may play in the delivery of guidelines-based metabolic dysfunction-associated steatohepatitis (MASH) care.
OBJECTIVE: Accelerate the application of guidelines-based MASH care pathways to clinical workflows.
METHODS: A panel of six hepatologists was convened in 2021 to develop the care pathway and the subsequent pilot occurred between 2022 - 2023. The pilot was conducted across three U.S. health systems: Boston Medical Center (Boston), Methodist Health System (Dallas), and Weill Cornell Medicine (New York). Clinicians were educated on the care pathway and completed baseline/follow-up assessments. 19 primary care clinicians participated in the educational pilot baseline assessment, nine primary care clinicians completed the two-month assessment, and 15 primary care clinicians completed the four-month assessment. The primary endpoint was to assess clinician-reported adherence to and satisfaction with the care pathway. The pilot was deemed exempt by the Western Consensus Group Institutional Review Board.
RESULTS: At baseline, 38.10% (n = 8) of respondents felt they had received sufficient training on when to refer a patient suspected of metabolic dysfunction-associated liver disease to hepatology, and 42.86% (n = 9) had not referred any patients suspected of metabolic dysfunction-associated liver disease to hepatology within a month. At four months post-intervention, 79% (n = 15) of respondents agreed or strongly agreed they received sufficient training on when to refer a patient suspected of metabolic dysfunction-associated liver disease to hepatology, and there was a 25.7% increase in self-reported adherence to the institution\'s referral guidelines. Barriers to care pathway adherence included burden of manually calculating fibrosis-4 scores and difficulty ordering non-invasive diagnostics.
CONCLUSIONS: With therapeutics anticipated to enter the market this year, health systems leadership must consider opportunities to streamline the identification, referral, and management of patients with metabolic dysfunction-associated steatohepatitis. Electronic integration of metabolic dysfunction-associated steatohepatitis care pathways may address implementation challenges.