Liver Function Tests (LFTs) are commonly abnormal, however; the diagnostic approach to individuals with deranged LFTs is variable, with lengthy processes and an increasing number of referrals to tertiary services and sub-optimal investigation of many patients. The aim of the project was to improve diagnostic proficiency, improving quality of investigation, reducing overall costs to practitioners and patients and reducing secondary care referrals.Methods
The project developed a functional automated ‘intelligent LFT’ (iLFT) system.Methods
This algorithm uses the combination of diagnostic criteria for liver disease, an investigation ordering and reporting system, and the tracked blood sciences system. iLFT produces a diagnosis or description of the abnormality with staging information and suggestions for further management. In general allowing allocation to 3 broad outcomes series of outcomes; a) diagnosis requiring complex treatment or advanced liver disease, b) a diagnosis of early or simple liver disease, c) where a clear diagnosis is not made; the GP receives staging and prognostic information including referral criterion.Methods
A step wedge design trial was conducted in 6 GP practices (covering 30 000 patients). Patients with LFTs measured in the previous 6 months with abnormalities were retrospectively used as controls. During the intervention period (6 months); GPs requested the iLFT option and those patients with abnormal LFTs were assessed.Results
Of 719 patients recruited, (Controls=490; interventional group=229) the iLFT system increased the diagnosis liver disease from first test abnormal LFT cohorts from 16% to 56%. The adjusted (for the step wedge design) difference in rate of liver disease diagnosis was a highly significant increase of 43% (95% CI 27%, 59%)Results
Health economic analysis showed an incremental care-equivalent ratio (ICER) of £284 and over a patient lifetime increased quality adjusted life years and saving the NHS (or equivalent healthcare providers) an average £3216 per patient – an unequivocally dominant strategy.Conclusions
iLFT increases liver disease diagnosis, improving quality of care and is unequivocally cost effective. These outcomes can be achieved with minor changes to working practices and existing lab infrastructure and ultimately aim to Result in appropriation of individuals being managed in the most apposite clinical infrastructure.