Introduction and Objective: Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD) affects ~60% of those with T2DM yet is under-recognized, even in specialty endocrinology practices. This Quality Improvement study aims to assess baseline MASLD screening rates in a diabetes clinic and evaluate whether an EHR-based intervention increases disease recognition and early management.Methods: Medical charts from an endocrinology fellows’ diabetes clinic in NYC were reviewed for three months before and after implementing an EHR-based FIB-4 score and MASLD clinical decision tool (June-Nov 2024). Adults with T2DM were included; exclusions were T1DM, pregnancy, viral hepatitis, cirrhosis, alcohol misuse. Primary endpoints were EHR tool usage, MASLD recognition, and specialist/imaging referrals. Demographic and clinical data were collected and analyzed using descriptive statistics and logistic regression.Results: The pre-intervention cohort (109 patients) was 65% female, 36% Black, 52% Latino, and 2% White, with avg BMI 29, A1c 8.5%, and FIB-4 2.33. The post-intervention cohort (135 patients) was 75% female, 40% Black, 46% Latino, and 1% White, with avg BMI 31, A1c 8.3%, and FIB-4 1.61. Before the intervention, 13.8% (15/109) of encounters documented MASLD or used FIB-4. Of the 46 patients requiring further workup based on FIB-4, only 2 were sent for imaging and 5 to a nutritionist, while 0/8 patients with advanced fibrosis risk had referrals. Post-intervention, 59.3% (80/135) of encounters documented MASLD or FIB-4, and 51% used the EHR tool. Among 58 patients requiring further workup, 22 received referrals for nutrition, imaging or specialist care, including 5/10 patients with advanced fibrosis risk.Conclusion: Post-EHR intervention, MASLD recognition increased by 37% and early management by 23% in patients with T2DM. However, the tool’s uptake of 51% underscores the need to examine physician perspectives on barriers to use and limitations in clinical practice.
M.I. Manolas: None. L. Rasquin Leon: None. S. Sachdev: Consultant; Trovo Health Inc. B.E. Fortune: Consultant; WL Gore and Associates, Gilead Sciences, Madrigal Pharmaceuticals, Inc. Other Relationship; BD Medical.
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