A new nurse practitioner (NP)-led referral model dramatically accelerates specialist care for patients at risk of advanced liver fibrosis, cutting wait times from nearly three months to under three weeks, according to data presented at The Liver Meeting 2026: American Association for the Study of Liver Diseases (AASLD).
Led by Andres Castillo, FNP-BC, of Northwestern Medicine Central Dupage Hospital in Winfield, Illinois, the initiative automatically routes patients with abnormal liver stiffness measurements (LSM $\ge$ 8 kPa) on vibration-controlled transient elastography (VCTE) directly to a dedicated metabolic dysfunction-associated steatotic liver disease (MASLD) clinic.
Key Results
Analyzing 253 screened patients (64 high-risk) before and after the pathway’s July 2025 launch revealed major gains in care delivery:
- 76% Faster Care: Median time from abnormal screening to a completed hepatology visit plummeted from 81.5 days to 19.5 days (P = .003).
- Doubled Timely Access: Patients evaluated within 60 days jumped from 35.7% to 83.3%.
- 3x Visit Completion: High-risk patients were three times more likely to complete a specialist visit under the NP-led model (adjusted hazard ratio, 3.10; P = .002).
- Closing the Follow-Through Gap: While initial referral rates (~95%) and referral times (1–2 days) stayed constant, the NP-led pathway successfully converted orders into completed appointments.
Why It Matters
High-risk patients (LSM $\ge$ 8 kPa) carried significantly heavier metabolic burdens—including 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%)—making rapid intervention essential.
“Embedding NP-led pathways in MASLD screening programs is a practical, scalable approach to linking at-risk patients with specialist care,” the authors stated. “Earlier evaluation allows patients with clinically significant fibrosis to begin treatment sooner and patients with cirrhosis to enter hepatocellular carcinoma surveillance without delay.”
Reference
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.
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