NP-Led Referral Pathway Tied to Faster Hepatology Visits

TOPLINE After the implementation of a nurse practitioner (NP)-led referral pathway in a metabolic dysfunction-associated steatotic liver disease (MASLD) screening program, the median time to a hepatology visit dropped from about 82 days to about 20 days for patients with liver stiffness measurement (LSM) ≥ 8 kPa on vibration-controlled transient elastography (VCTE).

The share of patients evaluated within 60 days climbed from approximately 36% to 83%. METHODOLOGY Clinicians increasingly rely on LSM by VCTE to screen for advanced fibrosis in MASLD, yet patients with abnormal results often face lengthy delays before seeing a hepatologist. On July 1, 2025, researchers launched an NP-led referral pathway that referred patients to a MASLD clinic when VCTE showed an LSM ≥ 8 kPa; they then assessed how the pathway affected time to a hepatology visit and profiled patients with elevated LSM.

They included 253 patients (median age, 63 years; 56.1% men) who underwent VCTE in a MASLD screening program between January and December 2025; 64 had an LSM ≥ 8 kPa. The team compared patients with elevated LSM scanned before (n = 28) and after (n = 36) the launch of the pathway.

The outcome was the number of days from VCTE to first hepatology visit. Patients not seen by 365 days, or by the time of the data pull, were censored. TAKEAWAY The median time to a hepatology visit shortened from 81.5 days before the implementation of the pathway to 19.5 days after (log-rank P = .003), with the rate of completing a hepatology visit about three times as high after implementation as before (adjusted hazard ratio, 3.10; P = .002).

Within 60 days of an abnormal VCTE result, the share of patients completing a hepatology visit rose from 35.7% to 83.3%. Patients with an LSM ≥ 8 kPa had a higher median BMI (32.6 vs 29.3) and higher rates of diabetes (60.9% vs 45.5%) and obesity (68.8% vs 44.4%) than those with an LSM < 8 kPa ( P < .05 for all).

Referral rates were similar before and after implementation of the pathway (96.4% vs 94.4%), with a median time to referral of 2 vs 1 day, suggesting that faster care was associated with more timely conversion of referrals into completed visits. IN PRACTICE "Embedding NP-led pathways in MASLD screening programs is a practical, potentially scalable approach to linking at-risk patients with specialist care," the authors wrote.

"Earlier evaluation allows patients with clinically significant fibrosis to begin treatment sooner and patients with cirrhosis to enter HCC [ hepatocellular carcinoma ] surveillance without delay," they added. SOURCE The study was led by Andres Castillo, FNP-BC, Northwestern Medicine Central Dupage Hospital, Winfield, Illinois.

It was presented at The Liver Meeting 2026: American Association for the Study of Liver Diseases (AASLD) in Denver, Colorado. LIMITATIONS The study did not report any specific limitations. DISCLOSURES No funding or conflicts of interest information was provided in the source poster.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.