Improving Diagnosis and Management of Non-Alcoholic Fatty Liver Disease in the Primary Care Setting

Background: Non-alcoholic fatty liver disease (NAFLD) in the United States continues to increase with the rise in obesity and type 2 diabetes. The prevalence of NAFLD in 2015 was 83.1 million. The prevalence of this disease is expected to increase to 100.9 million by 2030. Provider knowledge gaps regarding the diagnosis and management of NAFLD in primary care settings have been identified in previous studies. The rise of NAFLD cases in the community, coupled with provider knowledge gaps regarding the management of this disease in the primary care setting have been identified as areas that need quality improvement. Quality improvement in these areas can help decrease the progression of NAFLD cases, as well as improve diagnosis and management in the primary care setting. Methods: A quality improvement project was developed to help improve the diagnosis and management of NAFLD in the primary care setting. An evidence-based practice algorithm was developed after assessing the needs of the primary care providers (PCPs) at a single primary care clinic. An educational PowerPoint presentation about the diagnosis and management of NAFLD was sent to providers, followed by a post-educational presentation survey to assess improvement in previously identified knowledge gaps. The NAFLD algorithm was designed based on the expertise of a hepatologist and on current evidence- based literature. The algorithm was dispersed to providers at the end of the educational presentation and via electronic communication. Results: Pre-intervention, Fibroscan referral rates were at 6% (n=3). Post-intervention, Fibroscan referral rates increased to 9% (n=4). Of the 25 total participating providers, 2 (8%) took the post-implementation survey. 50% (n=1) of the participants reported satisfaction with the NAFLD algorithm, while the other 50% (n=1) felt that the NAFLD algorithm needed some changes and needed to be more accessible. Conclusions: The NAFLD algorithm may be a valuable tool to assist PCPs with diagnosing and managing NAFLD. It may also be a valuable resource to decrease unnecessary hepatology referrals. Adjustment of the NAFLD algorithm and replication of this quality improvement project is necessary to determine if it truly is a valuable resource.