Real-World Implementation of the AGA MASLD Pathway: Successes, Challenges and Key Takeaways

Key Results of MASLD Screening Implementation

Patient Population:

Total patients assessed: 16,183 (no prior MASLD diagnosis).

At-risk patients for CSF: 9,480 (58.6%).

Average age: 60.7 years.

Demographics:

65% female.(MASLD) has rapidly become a leading indication for liver transplantation.

In response, the American Gastroenterological Association (AGA) has introduced a clinical care pathway to guide the screening, diagnosis, and treatment of MASLD.

Despite these recommendations, MASLD remains underrecognized, often resulting in delayed interventions and worse outcomes for affected individuals.

A quality improvement initiative aims to

Addressing the Growing Burden of MASLD: A Focus on Early Intervention

address this gap by focusing on the screening and identification of high-risk patients with clinically significant fibrosis (CSF, Fibrosis Stage >2).

Early intervention is the goal, with the objective of improving clinical outcomes and preventing progression to cirrhosis.

Implementation of MASLD Clinical Care Pathway

Scope: Deployed across four practices: Internal Medicine, Endocrinology, Weight Management and Gastroenterology.

Screening Tool: Developed an EMR-based smart tool using FIB-4 to identify at-risk patients.

Provider Training: Conducted Provider Education Sessions (PES) quarterly from April 1,2023 to April 30, 2024 to improve pathway adherence.

Referral Process: At-risk patients were referred directly for Fibroscan testing and MASLD clinic evaluation.

Guideline Basis: Pathway aligned with AGA MASLD clinical care guidelines.

49.5% Black, 14% Hispanic.

Prevalence of Cardiometabolic Risk Factors:

Type II diabetes: 58%.

Obesity: 39%.

Hypertension (HTN): 80%.

Screening and Diagnosis:

At-risk patients screened: 2,025 (21.4%).

Patients identified with clinically significant fibrosis (CSF): 99.

Key Insight

The pilot MASLD screening pathway identified 1 in 10 patients with clinically significant fibrosis, closing critical diagnostic gaps in a diverse New York City community. By addressing disparities in MASLD care, this approach improves outcomes and reduces healthcare costs through early detection and intervention.

By - Eeshan Aggarwal

Reference: Hepatology. Volume 80, Issue S1. Abstract Supplement for The Liver Meeting by the American Association for the Study of Liver Diseases (AASLD), November 15-19, 2024, San Diego, CA.