Clinical decision support automates care gap detection among primary care patients with nonalcoholic fatty liver disease

Background: Although guidelines recommend primary care-driven management of NAFLD, workflow constraints hinder feasibility. Leveraging electronic health records to risk stratify patients proposes a scalable, workflow-integrated strategy.

Materials and methods: We prospectively evaluated an electronic health record-embedded clinical decision support system's ability to risk stratify patients with NAFLD and detect gaps in care. Patients missing annual laboratory testing to calculate Fibrosis-4 Score (FIB-4) or those missing necessary linkage to further care were considered to have a gap in care. Linkage to care was defined as either referral for elastography-based testing or for consultation in hepatology clinic depending on clinical and biochemical characteristics.

Results: Patients with NAFLD often lacked annual screening labs within primary care settings (1129/2154; 52%). Linkage to care was low in all categories, with <3% of patients with abnormal FIB-4 undergoing further evaluation.

Discussion: Significant care gaps exist within primary care for screening and risk stratification of patients with NAFLD and can be efficiently addressed using electronic health record functionality.