Table 3.
UK key performance indicator (KPI) results comparing centres with multidisciplinary services (MD) vs. centres without multidisciplinary services (no MD).
| Management of people with, or at risk of, NAFLD before the gastroenterology or liver clinic | N | No MD (%) | N | MD (%) | p value |
|---|---|---|---|---|---|
| 1. Services should have an agreed local clinical pathway for the investigation of suspected liver disease that includes an assessment for liver fibrosis using available non-invasive liver fibrosis tests | 13 | 69.2 | 21 | 90.5 | 0.02 |
| 2. Individuals referred to secondary care with suspected NAFLD should have their non-invasive fibrosis staging (e.g. FIB-4 score or NAFLD fibrosis score) documented in the referral letter. |
298 |
26.2 |
471 |
28.7 |
0.51 |
|
Investigations and management in secondary care |
|||||
| 3. People with NAFLD should have their weight and BMI documented | 298 | 69.8 | 471 | 75.8 | 0.08 |
| 4. People with NAFLD should have an alcohol history documented and advice given, where appropriate | |||||
| a) Documented | 298 | 88.9 | 471 | 91.5 | 0.26 |
| b) Advice given where appropriate | 165 | 33.3 | 307 | 57.7 | <0.01 |
| 5. People with NAFLD should have a smoking history documented and advice given, where appropriate | |||||
| a) Documented | 298 | 43.6 | 471 | 62.0 | <0.01 |
| b) Advice given where appropriate | 92 | 12.0 | 161 | 14.3 | 0.70 |
| 6. People with NAFLD should undergo liver fibrosis staging using available non- invasive tests or liver biopsy | 298 | 69.5 | 471 | 85.4 | <0.01 |
| Transient elastography/Fibroscan requested/performed | 298 | 63.1 | 471 | 80.9 | <0.01 |
| ELF requested | 298 | 3.4 | 471 | 7.6 | 0.02 |
| Ultrasound Acoustic Radiation Force Impulse (ARFI) requested | 298 | 0.3 | 471 | 0.6 | >0.99 |
| NFS score calculated | 298 | 4.4 | 471 | 0.8 | <0.01 |
| FIB-4 score calculated | 298 | 17.8 | 471 | 17.6 | >0.99 |
| Liver biopsy | 298 | 6.4 | 471 | 6.8 | 0.88 |
| 7. Patients with NAFLD should be screened for T2DM | 298 | 23.2 | 471 | 39.1 | <0.01 |
| Diabetic patients advised on optimising diabetes control | 117 | 29.9 | 217 | 42.4 | 0.03 |
| 8. People with NAFLD should be screened for hypertension | 298 | 15.4 | 471 | 21.4 | 0.05 |
| Patients with hypertension advised on optimising blood pressure control | 135 | 13.3 | 247 | 19.4 | 0.16 |
| 9. Patients with NAFLD should have weight loss advice documented including objective goals for weight change and physical activity. | |||||
| (a) Assessment of physical activity | 298 | 28.2 | 471 | 44.8 | <0.01 |
| (b) Assessment of dietary habits | 298 | 31.2 | 471 | 42.3 | <0.01 |
| (c) Exercise advice given | 283 | 45.2 | 447 | 61.7 | 0.06 |
| (d) Weight loss target given | 278 | 25.5 | 444 | 36.5 | <0.01 |
| (e) Tailored dietary advice | 278 | 28.4 | 452 | 40.7 | <0.01 |
| 10. Patients who are at increased cardiovascular risk (T2DM and/or QRISK-3 >10%) should be offered statin treatment in accordance with NICE guidelines. | 137 | 3.6 | 197 | 13.2 | <0.01 |
| 11. Patients should be provided with written information about NAFLD and weight management and/or signposted to credible information sources. | 248 | 9.3 | 434 | 24.7 | <0.01 |
Bold values signifies significant p <0.05.
ELF, Enhanced Liver Fibrosis; FIB-4, Fibrosis 4; MD, percentage of positive responses for each KPI in hospitals with multidisciplinary services; N, total number of recorded responses for each KPI; NAFLD, non-alcoholic fatty liver disease; NFS, NAFLD fibrosis score; NICE, National Institute for Health and Care Excellence; no MD (multidisciplinary services), percentage of positive responses for each KPI in hospitals without multidisciplinary services; T2DM, type 2 diabetes mellitus.