ArticleEndocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists2025
Assessing Clinician Engagement With a Passive Clinical Decision Support System for Liver Fibrosis Risk Stratification in a Weight Management Clinic.
Article in Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Embedding metabolic dysfunction-associated steatotic liver disease fibrosis risk stratification within pharmacist-integrated diabetes comanagement in primary care.Journal of managed care & specialty pharmacy · 2026Article
- Predictive modeling and clinical decision tools for risk stratification in steatotic liver disease.Clinical and molecular hepatology · 2026Review
- Failing to succeed: advancing mechanistic understanding of implementation strategies through retrospective and prospective use of causal pathway diagrams.Implementation science communications · 2025Article
- [Research progress and future prospects for artificial intelligence in the diagnosis and treatment of fatty liver disease].Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology · 2025Review
- Failing to Succeed: Advancing Mechanistic Understanding of Implementation Strategies Through Retrospective and Prospective Use of Causal Pathway Diagrams.Research square · 2025Article
Corrections and comments
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Authors and funding
9 authors.
Funding
Abstract
objectiveMetabolic dysfunction-associated steatotic liver disease is common in obesity. Guidelines recommend liver fibrosis risk stratification with tools such as Fibrosis-4 (FIB-4) index, liver stiffness measurement with vibration-controlled transient elastography (VCTE) and/or hepatology referral for elevated FIB-4. Despite recommendations, implementation remains limited. Using mixed methods, we evaluated a 3-strategy implementation bundle to improve fibrosis risk stratification-a FIB-4-based electronic health record embedded clinical decision support system (CDSS), educational outreach, and internal facilitation in a weight management clinic.
methodsThe primary outcome was penetration: the proportion of patients with elevated FIB-4 completing VCTE or hepatology referral. We compared rates, pre and postactivation of implementation bundle using Fischer's exact test. Semi-structured provider interviews, guided by the i-PARIHS framework, assessed acceptability and feasibility 3 months postimplementation.
resultsIn the preactivation phase, 880 out of 3933 (22.4%) weight management visits had the necessary labs to calculate automated FIB-4 scores with 128 elevated scores. In the postactivation phase, 2513 of 4634 weight management visits (54.2%) had automated FIB-4 scores; with 234 elevated score. Preactivation, there were no VCTE and 2 hepatology referrals. Postactivation, there were 3 VCTE referrals and 2 hepatology referrals (Fischer's exact test P value = 1.00). Providers cited shared responsibility with primary care, low awareness and trust in risk-stratification tools, workflow challenges, and competing demands as barriers. Educational outreach and facilitation improved CDSS engagement, while technical issues reduced it.
conclusionThis implementation strategy bundle did not achieve meaningful metabolic dysfunction-associated steatotic liver disease fibrosis risk stratification. Electronic health record-based CDSS shows promise but requires alignment with provider priorities, seamless workflow integration, and robust technical infrastructure.
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