S2362 Increasing GLP-1 Prescription Rates in Patients With Metabolic Dysfunction-Associated Steatotic Liver Disease and Obesity: A Quality Improvement Initiative

Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) affects over 30% of US adults and is the most common chronic liver disease in Western nations. Obesity, a significant comorbidity, drives MASLD progression to cirrhosis, ultimately drastically increasing healthcare costs. Modeling studies suggest that effective therapies for MASLD, particularly those halting fibrosis progression, could avert $7.6 billion in healthcare costs. Glucagon-like peptide-1 receptor agonists and glucose-dependent insulinotropic polypeptide receptor agonists (GLP1s) have demonstrated efficacy in MASLD reversal. Data gathered from 1108 patients seen in the gastroenterology clinic over the past 2 years showed a baseline GLP1 prescription rate of 22.9% in patients with comorbid obesity and MASLD/MASH. Based on this data, we conducted a preliminary quality improvement (QI) project to increase GLP1 prescription rates to reduce MASLD cirrhosis-related financial healthcare burden. Methods: An online provider survey (35% response from 150 internal medicine and GI providers) identified the prior authorization (PA) as the primary barrier to prescription. In response, we delivered an educational lecture to Gastroenterology and Internal Medicine trainees and staff that included a flowchart on the qualifying criteria for a GLP1. Prescription rate was reassessed after 2 months in 100 patients. While the sample size and time frame are limited, this was intended as an initial gap analysis and test of intervention impact. As a process measure, the rate of GLP1 prescription in the Hepatology clinic was also assessed during this time. Results: After the intervention, the prescription rate increased to 29%. Though still below our goal of >75%, this early improvement supports expanding the project. However, amongst patients seen in the Hepatology Clinic, only 5% of eligible patients evaluated during this time were prescribed a GLP1. Conclusion: This preliminary study illustrates that education alone is insufficient to substantially improve GLP1 prescription rates in patients with MASLD. A multi-faceted approach addressing broader systemic issues, such as policy change or system-level interventions, is necessary to enhance prescription rates and ultimately make an impact on the cost associated with the complications of progression to cirrhosis. Our future efforts will involve larger sample sizes, longer interval follow-up, and multiple cycles to test and refine interventions.