Underrecognition and Suboptimal Quality of Care for Nonalcoholic Fatty Liver Disease Cirrhosis in Primary Care Patients with Diabetes Mellitus.
Academic Article
Overview
abstract
BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is a leading cause of cirrhosis but is underrecognized in primary care. Cirrhosis management requires complex monitoring, and the quality-of-care (QoC) for NAFLD cirrhosis patients in primary care may be inadequate. METHODS: In this retrospective-prospective cohort study of primary care patients with diabetes mellitus, we identified patients with NAFLD cirrhosis by 1) evidence of cirrhosis from abdominal imaging, identified by natural language processing and/or 2) existence of ICD code for cirrhosis. A finding of either was followed by manual chart review for confirmation of both cirrhosis and NAFLD. We then determined if cirrhosis care measures were up to date, including hepatitis A and B vaccination, MELD score components, esophagogastroduodenoscopy (EGD), and hepatocellular carcinoma screening. We created a composite score quantifying overall QoC (scale 0-8), with high QoC as ≥6 points. RESULTS: Among 3,028 primary care patients with diabetes mellitus, we identified 51 (1.7%) with NAFLD cirrhosis. Although 78% had ≥3 average primary care visits/year, only 24% completed hepatocellular carcinoma screening at least annually in at least 75% of years since diagnosis. The average QoC composite score was 4.9 (SD 2.4), and less than 1/3 had high QoC. CONCLUSIONS: NAFLD cirrhosis is prevalent but underdiagnosed in primary care, and receipt of comprehensive QoC was suboptimal. Given the rising NAFLD cirrhosis incidence, primary care providers need improved awareness and mechanisms to ensure high QoC to this population.
