2485-P: Feasibility and Implementation of an Electronic Health Record-Enabled MASH Care Pathway in Diabetes
CASEY, MR; SPRATT, SE; LI, J; ALEXOPOULOS, A; AKHTER, N; SCHAFFER, A; CORSINO, L; DINANI, A
Published in: Diabetes
Introduction and Objective: Screening for metabolic dysfunction-associated steatohepatitis (MASH) in type 2 diabetes (T2D) is recommended by multiple society guidelines. Guideline-based MASH care pathways can be operationalized in the electronic health record (EHR) to systematically screen and identify patients at risk for MASH. This study evaluated the feasibility of an EHR-based MASH care pathway in patients with T2D. Methods: In November 2025, we deployed an EHR-based MASH Care Pathway across Endocrinology clinics in Duke University Healthcare System for patients with T2D and ALT >40 IU/L. Eight primary care providers were also included to compare uptake and practice patterns between specialties. Feasibility was assessed by examining rates of provider engagement and the proportion of pathway-recommended vs. completed orders. Results: The care pathway was assigned to 1065 patients in the first month. Only 61 (5.7%) providers followed the prompt to order FIB-4 labs on those patients. Among 376 providers who were prompted to calculate FIB-4, only 27 (7.2%) used the embedded FIB-4 calculator. The distribution of FIB-4 values across the 1065 patients assigned the care pathway was: 21% low risk (<1.3), 18% indeterminate risk (1.3- <2.67), and 8% high risk (≥2.67); the majority (53%) did not have FIB-4 calculated. When the pathway was used, it led to high rates of guideline-aligned care, i.e., of the 5 patients for whom Hepatology referral was recommended, 2 were referred; of the 10 recommended for transient elastography, 9 had orders placed via the care pathway (an additional 2 patients had transient elastography ordered outside of the care pathway). Conclusion: While engagement with the MASH Care Pathway was overall low (<10%), when used, this EHR-enabled care pathway led to high rates of guideline-aligned care of MASH in T2D.
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