Metabolic Dysfunction-associated Steatotic Liver Disease (MASLD) Fibrosis Risk Assessment Using an Electronic Health Record Alert in Primary Care

What this Trial Is About

Researchers are evaluating a new electronic health record (EHR) alert designed to help primary care providers assess the risk of advanced fibrosis in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). This chronic liver condition affects about one in three people in the U.S. and is linked to diabetes and obesity. The study uses a stepped wedge, cluster randomized design to test how well this alert works in improving MASLD management in primary care settings. The study introduces a non-interruptive EHR alert that appears when MASLD is diagnosed or suspected in a patient's record. This alert prompts clinicians to use an integrated tool to calculate the Fibrosis-4 Index (FIB-4), a low-cost test indicating fibrosis risk. If the risk is high, the alert recommends ordering a liver stiffness measurement (LSM) via ultrasound elastography to confirm fibrosis status. Clinics start in a control phase and transition to using the alert in five steps at six-month intervals, with a one-month transition period to provide education and system access. Participants include patients with MASLD and primary care clinicians. The study tracks the detection of advanced fibrosis up to five years after alert implementation. Researchers will also measure how often eligible patients receive liver stiffness tests, how many clinicians order these tests, patient completion rates of testing, and whether clinics continue using the alert over time. This ongoing monitoring aims to understand the alert's adoption, accuracy, and sustainability in real-world care.

Advanced Fibrosis Detection for MASLD in Primary Care