P1248 - FIB-4 Reporting in EHR Impacts Liver Clinic Referrals of Patients With Diabetes

Gyorgy Baffy, MD, PhD, FACG¹, Emilie K. Mitten, MD², Sarah Altajar, MD³, Nathanael Fillmore, PhD¹, Nhan Do, MD¹, Mary Brophy, MD¹, Theodore Feldman, PhD^1
1VA Boston Healthcare System, Boston, MA; ²Brigham and Women's Hospital, Boston, MA; ³Boston University Chobanian & Avedisian School of Medicine, Miami, FL

Introduction: Metabolic dysfunction-associated fatty liver disease (MASLD) represents increased risk of advanced liver disease in patients with type 2 diabetes (T2D). FIB-4 is a primary screening tool for liver fibrosis. In 2020, we began reporting FIB-4 in the electronic health records (EHR) at our hospital and analyzed the impact on specialty referral practices. Preliminary findings were presented earlier.

Methods: Patients diagnosed with T2D (HgbA1c >6.5% at least once) and seen in primary care clinics between 2011-2022 were identified. Subgroups of patients with low (LO, < 1.3), intermediate (IM, 1.3-2.67), and high (HI, >2.67) FIB-4 values were defined. GI consults placed each year were analyzed by individual chart review and data were compared preceding (2011-2019) and following (2020-2022) the start of FIB-4 reporting.

Results: A total of 14,280 individual patients with T2D seen in primary care at our hospital within the study period were identified. The average size of annualized cohorts was 4,403. Laboratory parameters allowed FIB-4 calculation in 64.8% of these cases, identifying 37.8%, 51.1%, and 11.1% with LO, IM, and HI FIB-4 scores, respectively, with no significant difference in annual distribution. The number of outpatient GI consults placed each year ranged from 364 to 712 (10.1% to 15.7%, NS). Of these, liver referrals averaged 11.8% with sustained numbers despite a sharp decline in overall GI referral rates after the onset of pandemic. Specifically, referral for abnormal liver tests seen prior to 2020 increased immediately in 2020 (25.4% vs. 43.4%, P=0.03) and maintained a yearly average of 39.3% (NS). Median of referrals for cirrhosis and abnormal liver tests for patients with IM and HI FIB-4 increased by 2.0x and 1.9x (P=0.017, 0.014), respectively. HCV-related referrals sharply dropped between the 2 periods (NS, P=0.013, 0.014 for LO, IM, and HI FIB-4), reflecting programmatic efforts of antiviral therapy prior to 2020. MASLD as a referral indication showed a less robust increase between the 2 periods (median 13.1% vs. 19.2%, NS). Finally, the average rate of liver-related referrals among patients with HI FIB-4 increased from 4.6% to 8.1% (NS) after FIB-4 reporting.

Discussion: Automated inclusion of pre-calculated FIB-4 in the EHR may change liver clinic referral practices and aid timely evaluation of liver health in patients with T2D. Additional steps may further improve clinician awareness, screening rates, and risk assessment of patients at increased risk for liver disease.


Disclosures:


Gyorgy Baffy, MD, PhD, FACG¹, Emilie K. Mitten, MD², Sarah Altajar, MD³, Nathanael Fillmore, PhD¹, Nhan Do, MD¹, Mary Brophy, MD¹, Theodore Feldman, PhD¹. P1248 - FIB-4 Reporting in EHR Impacts Liver Clinic Referrals of Patients With Diabetes, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.