About this trial
Non-alcoholic fatty liver disease (NAFLD) is a new condition that has become the most common chronic liver disease in the world and a main cause of liver cirrhosis, liver failure and liver cancer. Obesity and diabetes, conditions that are very common among Veterans are the main risk factors for NAFLD. Therefore, the burden of NAFLD and its complications among Veterans is substantial. However, most VA patients with NAFLD are undiagnosed and untreated, and their care is not consistent with practice guidelines. The NAFLD Clinical Care Pathway (NCCP) intervention seeks to close this major gap in the care of Veterans by automatically identifying patients at risk of NAFLD, calculating their risk scores of having severe NAFLD, and educating the primary care providers on the diagnosis and treatment of NAFLD. This clinical trial will test the benefit of this NCCP intervention against usual care in increasing the rates of NAFLD diagnosis as well as referral to and enrollment in appropriate treatment. The study will also identify barriers and promotors of future NCCP implementation.
Eligibility criteria
This trial accepts healthy volunteersQualifiers
None
Disqualifiers
The investigators will exclude PACTs with unstable leadership (i.e., pending departure, vacancy) at time of randomization.
PACTs participating in the focus groups in Aim 1 will be excluded in Aim 2 to avoid cross contamination.
PACTs who do not treat NAFLD,
PACTs not located at the main hospital,
Trial design
Parallel
Treatments tested in this trial
E-trigger
BehavioralThe NCCP Intervention is multicomponent. First, the investigators will apply the e-trigger and calculate FIB-4, and second, will educate and train PACT personnel on how to deal with trigger positive patients as well as make treatment recommendations within an inter-professional team. The e-trigger will be generated every 3 months. The effectiveness of the trigger will be assessed using the outcomes previously mentioned.
Treatment groups
Trial outcomes
Primary outcomes
NAFLD Diagnosis and risk stratification
The investigators will use chart reviews to extract unstructured data regarding the primary outcome measure: existence of EHR progress note documenting a new NAFLD diagnosis AND complete risk stratification of NAFLD (i.e., fibrosis). The investigators will use our validated process to guide uniform abstraction and classification.
Secondary outcomes
Fibroscan Test
The investigators will extract from the EHR if a patient had a fibroscan test.
Referral to hepatology
The investigators will extract from the EHR if a patient was referred to a hepatology clinic.
Hepatology Clinic Visit
The investigators will extract from the EHR if a patient was seen in a hepatology clinic.
NAFLD discussion
The investigators will extract from the patient chart if the provider documented a discussion about NAFLD with the patient.
Sponsors and contacts
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