P1776 - Quality Improvement: Increasing Utilization of the FIB-4 Score for Suspected Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD)

Bianca Thakkar, DO¹, Courtney Stead, MD², Courtenay Ryan-Fisher, MBBCh³, Roopjeet Bath, MBBS¹
1University of Connecticut Health, Farmington, CT; 2University of Connecticut Health Center, Farmington, CT; 3Uconn health, Hartford, CT

Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) affects an estimated 25–30% of the general population and is strongly associated with obesity, hypertension, and insulin resistance. Identifying patients at risk for advanced fibrosis is crucial, as fibrosis stage is the strongest predictor of liver-related outcomes. The Fibrosis-4 (FIB-4) score is a non-invasive, cost-effective tool validated to exclude advanced fibrosis, particularly useful in primary care and GI settings. A FIB-4 score < 1.3 suggests low risk and supports periodic reassessment, while scores ≥1.3 warrant further evaluation with elastography or specialist referral. However, FIB-4 score usage in GI clinics remains inconsistent. This QI initiative aimed to improve the documentation and utilization of FIB-4 scores among MASLD patients in outpatient GI clinics across four diverse outpatient offices.

Case Description/

Methods: We performed a retrospective chart review of patients seen in GI clinics over the prior year at four institutions in the northeastern United States, including a mix of academic medical centers, urban tertiary care hospitals, and community-based teaching hospitals. Inclusion criteria: age >35, hepatic steatosis on imaging or abnormal liver tests plus ≥1 cardiometabolic risk factor, without known advanced fibrosis or cirrhosis. The baseline rate of FIB-4 score calculation was assessed. A standardized Epic dot phrase (.fib4) was created and disseminated through provider education to improve uptake. Post-intervention chart reviews assessed the impact of these changes.

Discussion: Of 53 eligible patients reviewed at baseline, only 47% (25/53) had a FIB-4 score calculated. Following the intervention, this improved to 87% (46/53), representing a 40% absolute increase. The dot phrase was successfully integrated at three sites, with efforts ongoing at one institution. The intervention demonstrated that simple EMR-based tools and targeted education can significantly improve adherence to MASLD risk stratification guidelines.



MASLD is highly prevalent, and early identification of patients at risk for advanced fibrosis is essential. Implementation of a standardized FIB-4 score documentation tool and provider education significantly increased utilization of FIB-4 in GI outpatient settings. Continued QI efforts, including full integration across all sites, will further standardize MASLD care and improve downstream liver-related outcomes.

Disclosures:
Bianca Thakkar indicated no relevant financial relationships.
Courtney Stead indicated no relevant financial relationships.
Courtenay Ryan-Fisher indicated no relevant financial relationships.
Roopjeet Bath indicated no relevant financial relationships.

Bianca Thakkar, DO¹, Courtney Stead, MD², Courtenay Ryan-Fisher, MBBCh³, Roopjeet Bath, MBBS¹. P1776 - Quality Improvement: Increasing Utilization of the FIB-4 Score for Suspected Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD), ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.