{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T19:42:47Z","timestamp":1777923767436,"version":"3.51.4"},"reference-count":12,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2023,11,1]],"date-time":"2023-11-01T00:00:00Z","timestamp":1698796800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Metabolic Syndrome and Related Disorders"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Nonalcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease with increasing rates globally. Patients with type 2 diabetes mellitus have higher risk of developing NAFLD. Patients with a higher degree of liver fibrosis in NAFLD are at an increased risk for liver-related mortality, but get missed easily during the referral process. This project aims to improve early detection and linkage-to-care of fibrotic NAFLD patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We utilized a combination of automated electronic health record (EHR)-based fibrosis (FIB)-4 score and directed provider education. A health-system wide FIB-4 score calculator that providers can easily add to their workflow for NAFLD patient triaging. Data were analyzed at 6 and 12 months after implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Postimplementation, there was an increase in patients referred to hepatology with higher degree of liver fibrosis and decreased referral to hepatology with low risk of liver fibrosis, measured by FIB-4 score. At baseline, \u223c55% of referred patient to hepatology had FIB-4 score &lt;1.3 compared to 38% at 12 months postimplementation. There was an increase in referral of patients with FIB-4 scores &gt;1.3 when compared to preinterventions, 62% versus 45%. This is most pronounced in patients with severe fibrotic disease with FIB-4 score &gt;2.67, 30% versus 12%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Automated FIB-4 score in EHR can improve appropriate linkage-to-care for at-risk fibrotic NAFLD, especially when coupled with targeted provider education. The durability of such improvement is essential to study along with the need to increase broad acceptance across health systems.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/met.2023.0092","type":"journal-article","created":{"date-parts":[[2023,9,27]],"date-time":"2023-09-27T12:56:06Z","timestamp":1695819366000},"page":"475-478","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Improved Detection of Fibrotic Nonalcoholic Fatty Liver Disease in Community-Based Referrals"],"prefix":"10.1177","volume":"21","author":[{"given":"Cindy","family":"Piao","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, University of California, Davis, California, USA."},{"name":"Division of Gastroenterology and Hepatology, University of California, Davis, California, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elvis J.","family":"Arteaga","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of California, Davis, California, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuai","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, University of California, Davis, California, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aili","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of California, Davis, California, USA."},{"name":"Division of Endocrinology, Diabetes and Metabolism, University of California, Davis, California, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott T.","family":"Macdonald","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of California, Davis, California, USA."},{"name":"Clinical Informatics, University of California, Davis, California, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9358-4257","authenticated-orcid":false,"given":"Souvik","family":"Sarkar","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of California, Davis, California, USA."},{"name":"Division of Gastroenterology and Hepatology, University of California, Davis, California, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2023,11,15]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrgastro.2017.109"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.metabol.2020.154170"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrgastro.2016.3"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/3920196"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/6638306"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40618-017-0799-3"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2018.12.031"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2019.03.033"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2019.12.026"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1002\/hep.21669"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.3390\/pr9010135"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.3108\/3\/j.rcm2203082"}],"container-title":["Metabolic Syndrome and Related Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1089\/met.2023.0092","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/met.2023.0092","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/met.2023.0092","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T20:55:52Z","timestamp":1777668952000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1089\/met.2023.0092"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11]]},"references-count":12,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2023,11]]}},"alternative-id":["10.1089\/met.2023.0092"],"URL":"https:\/\/doi.org\/10.1089\/met.2023.0092","relation":{},"ISSN":["1540-4196","1557-8518"],"issn-type":[{"value":"1540-4196","type":"print"},{"value":"1557-8518","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11]]}}}