Identification of Nonalcoholic Fatty Liver Disease in Patients with Hepatitis C: Using Evidence Based Guidelines to Improve Diagnosis and Transition of Care from Specialty Care Provider to Primary Care Provider

Abstract

Chronic liver disease is a process that involves progressive destruction and regeneration of the liver causing fibrosis, cirrhosis and hepatocellular carcinoma, and early death. Persons with chronic liver disease treated for hepatitis C with abnormal radiological imaging consistent with increased fat content in the liver (hepatic steatosis) should be evaluated for nonalcoholic fatty liver disease (NAFLD). However, individuals treated at a community hepatitis C treatment clinic are currently not being evaluated for NAFLD. In addition, if NAFLD is diagnosed, management of these co-occurring conditions is required to delay disease progression. Factors contributing to gaps in NAFLD care include: poor communication, incomplete transfer of information, inadequate education of patients, and the absence of a single point person to ensure continuity of care.This Doctor of Nursing Practice (DNP) project involved the development and implementation of a protocol with person-centered education to assure continuity of care based on need of those with chronic liver disease, hepatitis C and NAFLD. Findings after the implementation and evaluation of the process improvement protocol at the clinic noted patients being treated for hepatitis C with hepatic steatosis: 1) were systematically evaluated for and diagnosed with NAFLD during treatment of hepatitis C infection at the clinic; 2) received NAFLD person-centered education; and 3) transitioned from specialty care after completion of hepatitis C infection treatment to primary care provider for ongoing NAFLD management