{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T18:40:32Z","timestamp":1787856032848,"version":"build-2784847793"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,7,20]],"date-time":"2024-07-20T00:00:00Z","timestamp":1721433600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,7,20]],"date-time":"2024-07-20T00:00:00Z","timestamp":1721433600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Prim. Care"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly referred to as nonalcoholic fatty liver disease, impacts 30% of the global population. This educational pilot focused on the role primary care providers may play in the delivery of guidelines-based metabolic dysfunction-associated steatohepatitis (MASH) care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Accelerate the application of guidelines-based MASH care pathways to clinical workflows.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A panel of six hepatologists was convened in 2021 to develop the care pathway and the subsequent pilot occurred between 2022 \u2013 2023. The pilot was conducted across three U.S. health systems: Boston Medical Center (Boston), Methodist Health System (Dallas), and Weill Cornell Medicine (New York). Clinicians were educated on the care pathway and completed baseline\/follow-up assessments. 19 primary care clinicians participated in the educational pilot baseline assessment, nine primary care clinicians completed the two-month assessment, and 15 primary care clinicians completed the four-month assessment. The primary endpoint was to assess clinician-reported adherence to and satisfaction with the care pathway. The pilot was deemed exempt by the Western Consensus Group Institutional Review Board.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      At baseline, 38.10% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20098) of respondents felt they had received sufficient training on when to refer a patient suspected of metabolic dysfunction-associated liver disease to hepatology, and 42.86% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20099) had not referred any patients suspected of metabolic dysfunction-associated liver disease to hepatology within a month. At four months post-intervention, 79% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200915) of respondents agreed or strongly agreed they received sufficient training on when to refer a patient suspected of metabolic dysfunction-associated liver disease to hepatology, and there was a 25.7% increase in self-reported adherence to the institution\u2019s referral guidelines. Barriers to care pathway adherence included burden of manually calculating fibrosis-4 scores and difficulty ordering non-invasive diagnostics.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>With therapeutics anticipated to enter the market this year, health systems leadership must consider opportunities to streamline the identification, referral, and management of patients with metabolic dysfunction-associated steatohepatitis. Electronic integration of metabolic dysfunction-associated steatohepatitis care pathways may address implementation challenges.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12875-024-02517-y","type":"journal-article","created":{"date-parts":[[2024,7,20]],"date-time":"2024-07-20T08:01:53Z","timestamp":1721462513000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Deploying a metabolic dysfunction-associated steatohepatitis consensus care pathway: findings from an educational pilot in three health systems"],"prefix":"10.1186","volume":"25","author":[{"given":"Sonal","family":"Kumar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arpan","family":"Mohanty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parvez","family":"Mantry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert E.","family":"Schwartz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madeleine","family":"Haff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Therapondos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mazen","family":"Noureddin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Dieterich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nigel","family":"Girgrah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristi","family":"Cohn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohanish","family":"Savanth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Fuchs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,7,20]]},"reference":[{"issue":"20","key":"2517_CR1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms20205037","volume":"20","author":"DH Fernando","year":"2019","unstructured":"Fernando DH, Forbes JM, Angus PW, Herath CB. Development and progression of non-alcoholic fatty liver disease: the role of advanced glycation end products. Int J Mol Sci. 2019;20(20): 5037. https:\/\/doi.org\/10.3390\/ijms20205037.","journal-title":"Int J Mol Sci"},{"issue":"1","key":"2517_CR2","doi-asserted-by":"publisher","DOI":"10.1016\/j.aohep.2023.101133","volume":"29","author":"ME Rinella","year":"2024","unstructured":"Rinella ME, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Ann Hepatol. 2024;29(1): 101133. https:\/\/doi.org\/10.1016\/j.aohep.2023.101133.","journal-title":"Ann Hepatol"},{"key":"2517_CR3","unstructured":"American Liver Foundation. Nash definition & prevalence. 2022. https:\/\/liverfoundation.org\/liver-diseases\/fatty-liver-disease\/nonalcoholic-steatohepatitis-nash\/nash-definition-prevalence\/#:~:text=NAFLD%20is%20the%20most%20common,of%20adults%20in%20the%20U.S"},{"key":"2517_CR4","unstructured":"American liver foundation. Nonalcoholic fatty liver disease (NAFLD). 2023. https:\/\/liverfoundation.org\/liver-disease."},{"issue":"2","key":"2517_CR5","first-page":"64","volume":"36","author":"LM Glass","year":"2019","unstructured":"Glass LM, Hunt CM, Fuchs M, Su GL. Comorbidities and nonalcoholic fatty liver disease: the chicken, the egg, or both? Federal practitioner: for the health care professionals of the VA, DoD, and PHS. 2019;36(2):64\u201371.","journal-title":"Federal practitioner: for the health care professionals of the VA, DoD, and PHS"},{"issue":"1","key":"2517_CR6","doi-asserted-by":"publisher","first-page":"31","DOI":"10.4093\/dmj.2019.0011","volume":"43","author":"YH Lee","year":"2019","unstructured":"Lee YH, et al. Nonalcoholic fatty liver disease in diabetes. Part I: epidemiology and diagnosis. Diabetes Metab J. 2019;43(1):31\u201345. https:\/\/doi.org\/10.4093\/dmj.2019.0011.","journal-title":"Diabetes Metab J"},{"issue":"5","key":"2517_CR7","doi-asserted-by":"publisher","first-page":"1797","DOI":"10.1097\/hep.0000000000000323","volume":"77","author":"ME Rinella","year":"2023","unstructured":"Rinella ME, Neuschwander-Tetri BA, Siddiqui MS, Abdelmalek MF, Caldwell S, Barb D, Kleiner DE, Loomba R. AASLD practice guidance on the clinical assessment and management of nonalcoholic fatty liver disease. 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Diabetes Care. 2023;46(9):1718\u201320. https:\/\/doi.org\/10.2337\/dc23-ad09.","journal-title":"Diabetes Care."},{"issue":"5","key":"2517_CR9","doi-asserted-by":"publisher","first-page":"1657","DOI":"10.1053\/j.gastro.2021.07.049","volume":"161","author":"F Kanwal","year":"2021","unstructured":"Kanwal F, Shubrook JH, Adams LA, Pfotenhauer K, Wai-Sun Wong V, Wright E, Abdelmalek MF, Harrison SA, Loomba R, Mantzoros CS, Bugianesi E, Eckel RH, Kaplan LM, El-Serag HB, Cusi K. Clinical care pathway for the risk stratification and management of patients with nonalcoholic fatty liver disease. Gastroenterology. 2021;161(5):1657\u201369. https:\/\/doi.org\/10.1053\/j.gastro.2021.07.049.","journal-title":"Gastroenterology"},{"issue":"5","key":"2517_CR10","doi-asserted-by":"publisher","first-page":"528","DOI":"10.1016\/j.eprac.2022.03.010","volume":"28","author":"K Cusi","year":"2022","unstructured":"Cusi K, Isaacs S, Barb D, Basu R, Caprio S, Garvey WT, Kashyap S, Mechanick JI, Mouzaki M, Nadolsky K, Rinella ME, Vos MB, Younossi Z. American association of clinical endocrinology clinical practice guideline for the diagnosis and management of nonalcoholic fatty liver disease in primary care and endocrinology clinical settings. Endocr Pract. 2022;28(5):528\u201362. https:\/\/doi.org\/10.1016\/j.eprac.2022.03.010.","journal-title":"Endocr Pract"},{"key":"2517_CR11","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1007\/s10620-022-07706-2","volume":"68","author":"KB Islam","year":"2023","unstructured":"Islam KB, Brandman D, Chu JN, et al. 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PMID:31592044;PMCID:PMC6771169.","journal-title":"Hepatol Commun"}],"container-title":["BMC Primary Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12875-024-02517-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12875-024-02517-y\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12875-024-02517-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,20]],"date-time":"2024-07-20T08:02:16Z","timestamp":1721462536000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcfampract.biomedcentral.com\/articles\/10.1186\/s12875-024-02517-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,20]]},"references-count":18,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["2517"],"URL":"https:\/\/doi.org\/10.1186\/s12875-024-02517-y","relation":{},"ISSN":["2731-4553"],"issn-type":[{"value":"2731-4553","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,20]]},"assertion":[{"value":"8 February 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 July 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 July 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The protocol was submitted to the WCG IRB and local review boards. The WCG IRB issued a statement of exemption under 45 CFR \u00a7 46.104(d)(1) because the research is conducted in established or commonly accepted educational settings and the research specifically involves normal educational practices that are not likely to adversely impact students\u2019 opportunity to learn required educational content or the assessment of educators who provide instruction. As such, the requirement for consent to participate was waived (for reference: work order #1\u20131557082-1).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Potential competing interests of the authors are disclosed as follows - SK reported receiving funding as a principal investigator for various clinical studies supported by Novo Nordisk, Inc., Gilead Sciences, Intercept Pharmaceuticals, CymaBay Therapeutics, Ipsen, Madrigal Pharmaceuticals; and as a speaker for events supported by Gilead Sciences, Ipsen, Novo Nordisk, Intercept Pharmaceuticals. AM reported receiving grant funding from Gilead Sciences and The Kinetix Group; and as a principal investigator for various studies supported by Novo Nordisk, Inc., Intercept Pharmaceuticals, and Inventiva Pharma; and for serving on an advisory board supported by Gilead Sciences. RS reported receiving compensation for serving on scientific advisory boards supported by Miromatrix Inc. and Lime Therapeutics; and a paid consultant and speaker for Alnylam Inc. GT reported receiving compensation as a participant in multiple advisory boards supported by Novo Nordisk. MN reported receiving compensation as a participant on advisory boards supported by Altimmune, Boehringer Ingelheim, CytoDyn, Corcept Therapeutics, 89BIO Inc, GSK, Madrigal Pharmaceuticals, Merck, Novo Nordisk, Inc., NorthSea Therapeutics, Terns Pharmaceuticals, and Takeda Pharmaceuticals; and as a principal investigator for studies supported by Allergan, Akero Therapeutics, BMS, Gilead Sciences, Galectin Therapeutics, Genfit, GSK, Conatus, Corcept Therapeutics, Enanta Pharmaceuticals, Madrigal Pharmaceuticals, Novartis, Novo Nordisk, Inc., Shire, Takeda Pharmaceuticals, Terns Pharmaceuticals, Viking, and Zydus; and reported being a stockholder in Rivus Pharma, CIMA, CytoDyn, and ChronWell, Inc. DD reported receiving compensation as a consultant for Novo Nordisk, Inc.; and as a speaker for events supported by Intercept Pharmaceuticals. NG reported receiving compensation as a participant of the speakers bureau supported by Gilead Sciences. KC and MS reported being employed by NASHNET\/The Kinetix Group. No other disclosures were reported.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"265"}}