SUN-709 - Improving Rates of Screening for Metabolic Dysfunction-Associated Steatotic Liver Disease in an Internal Medicine Resident Clinic: A QI Project

Introduction: Metabolic dysfunction–associated steatotic liver disease (MASLD) is the most common chronic liver disease worldwide and is highly prevalent among patients with obesity and type 2 diabetes. Despite guideline recommendations for risk-stratified screening using noninvasive tools such as the Fibrosis-4 (FIB-4) score, implementation in primary care remains inconsistent.

Objective: To increase appropriate MASLD screening among high-risk patients (BMI ≥30 kg/m² and/or type 2 diabetes) seen in a community-based primary care clinic by 50%.
Design and Setting: Quality improvement (QI) project conducted at North Hudson Community Action Corporation, a federally qualified health center affiliated with an internal medicine residency program.
Patients/Participants: 89 eligible adult patients seen between January and April 2024 (pre-intervention) and 100 eligible adult patients seen between December 2024 and February 2025 (post-intervention). Residents and attending preceptors participated in the intervention.
Interventions: Using the Model for Improvement and sequential Plan–Do–Study–Act cycles, we implemented low-effort, high-impact interventions including resident education during academic half-day, preceptor reminder emails, a laminated clinic-based MASLD screening algorithm, and visual prompts in patient rooms encouraging discussion of liver health.
Outcome Measures: The primary outcome was the proportion of eligible patients with documented FIB-4 scores. Secondary outcomes included completion of laboratory testing sufficient to calculate FIB-4, appropriate follow-up imaging or subspecialty referral for abnormal results, and resident-reported barriers to screening. Balancing measures included resident satisfaction, perceived visit length, and perceived laboratory burden.

Results: At baseline, only 1% of eligible patients had documented FIB-4 scores and none had undergone liver imaging. Following implementation, FIB-4 documentation increased to 18%, demonstrating non-random improvement on run-chart analysis. Completion of CBC testing within 1 year improved from 32.5% to 42%, while liver enzyme completion decreased modestly from 76.4% to 70%. Resident surveys demonstrated improved guideline awareness and reduced perception of screening as overly time-consuming. Balancing measures remained stable without evidence of increased visit duration or dissatisfaction.
Limitations: Screening was less consistent during tele-health, walk-in, and post-discharge visits and was influenced by visit complexity and preceptor engagement.

Conclusions: A resident-led, low-cost educational and workflow intervention bundle significantly improved MASLD screening. Embedding simple algorithms and reinforcing preceptor engagement can support guideline-concordant MASLD screening by non-hepatology clinicians.

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