Measuring NAFLD Models of Care: A New Strategic Framework?

Models of care (MoCs) establish comprehensive frameworks for the provision of healthcare services along a continuum of care.
PUBLISHED IN: Nature Reviews: Gastroenterology and Hepatology (June 2023)

COMMENT:

Non-alcoholic fatty liver disease (NAFLD)’s high global prevalence and multifaceted comorbidities warrant the development of context-specific and multidisciplinary MoCs. Indeed, ideal NAFLD MoCs encourage dialogue between hepatologists, primary care providers, endocrinologists, cardiologists, physical therapists, and mental health professionals with the aim of improving patient outcomes via early identification and effective intervention. To date, however, most NAFLD MoCs have not provided data on their effectiveness.

This comment provides a comprehensive framework for what should be measured and reported by research into NAFLD MoCs in order to maximise their effectiveness, generalisability, and clinical applicability.

Non-alcoholic fatty liver disease (NAFLD)’s high global prevalence and multifaceted comorbidities warrant the development of context-specific and multidisciplinary MoCs. Indeed, ideal NAFLD MoCs encourage dialogue between hepatologists, primary care providers, endocrinologists, cardiologists, physical therapists, and mental health professionals with the aim of improving patient outcomes via early identification and effective intervention. To date, however, most NAFLD MoCs have not provided data on their effectiveness.

This comment provides a comprehensive framework for what should be measured and reported by research into NAFLD MoCs in order to maximise their effectiveness, generalisability, and clinical applicability.

KEY LEARNINGS:

NAFLD MoCs for risk stratification must utilise NITs, defining appropriate cut-offs according to clinical outcomes instead of histology. Testing for metabolic parameters, e.g. dyslipidemia, type 2 diabetes and hypertension, should further be conducted. To avoid false positives and unnecessary waiting time for testing, MoCs should measure and present their effects on patient-reported outcomes and experiences. Research into MoCs should also disclose the area under the receiver operating curve as well as the sensitivity and specificity of the cut-offs used for the studied population. Similarly, reporting a MoC’s practical performance metrics and long-term effects on disparate hepatic and extrahepatic events is crucial to establishing its effectiveness. Moreover, published MoCs’ efficacy should be compared with the standard of care or previously published models to ensure generalisability. Lastly, to maximise their real-world applicability, NAFLD MoCs should be cost-effective and assess relevant disciplines’ willingness to implement them.

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S Duarte, BSc

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