# Improving Diagnostic Safety through STeatosis Identification, Risk stratification, and Referral in the ED (STIRRED)

> **NIH AHRQ R01** · NORTHWESTERN UNIVERSITY · 2023 · $500,000

## Abstract

PROJECT ABSTRACT
Nonalcoholic fatty liver disease (NAFLD) is a public health crisis affecting one third of the US adult population.
NAFLD is an obesity related disease with serious health and quality of life consequences including type 2
diabetes, cirrhosis, liver cancer, and cardiovascular disease. Despite serious threats to health and wellbeing,
NAFLD has not received the same attention as other cardiometabolic diseases like type 2 diabetes. In addition,
NAFLD is often asymptomatic and patients are frequently diagnosed when hepatic steatosis is reported as an
incidental finding on imaging studies or a patient develops advanced liver disease. Our prior work found
hepatic steatosis reported in just under 10% of written radiology reports. Unfortunately, lack of awareness often
leads to hepatic steatosis being overlooked by providers and unreported to patients leading to delays in
diagnosis and referral to specialty care. Our recent survey revealed only 13% of providers always reported this
finding to patients. This project, Improving Diagnostic Safety through STeatosis Identification, Risk
stratification, and Referral pathway in the ED (STIRRED), proposes to improve diagnostic safety by
ensuring that patients receive timely notification of the new finding and referral to follow up care. To date, we
have developed the building blocks for the STIRRED CDSS by employing natural language processing and
machine learning to identify hepatic steatosis in written emergency department (ED) radiology reports and
combine it with common clinical data and comorbidities in the electronic health record to create an
individualized risk profile and follow up recommendations for patients with suspected (NAFLD). Providing risk
stratified appropriate referrals for patients from the ED will increase diagnosis of NAFLD, enable those deemed
high risk for advanced liver disease to receive specialist referral and begin the important process of cancer
screening and intervention to improve steatosis. Communicating this incidental imaging finding and initiating
referral from the ED will enable linkage to care to improve health outcomes and reverse or slow disease
progression for those at all risk levels. While the groundwork for this intervention has been laid, for STIRRED
to be successful, it must be both refined further and implemented thoughtfully. Through Aim 1 and 2, we will
seek to: 1) determine the barriers, facilitators, and additional strategies to implement the STIRRED CDSS, and
2) conduct usability testing of the STIRRED CDSS. Upon finalizing the optimized STIRRED CDSS and
implementation plan, we seek to: 3) evaluate STIRRED across a large health system. This work will be led by
a team of experienced researchers with expertise in clinical trials, risk communication, patient communication,
diagnostic uncertainty, hepatic steatosis and NAFLD, incidental findings, implementation science, and health
services research. Completion of these aims will result in tools to im...

## Key facts

- **NIH application ID:** 10828499
- **Project number:** 1R01HS029777-01
- **Recipient organization:** NORTHWESTERN UNIVERSITY
- **Principal Investigator:** Amy V Kontrick
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2023
- **Award amount:** $500,000
- **Award type:** 1
- **Project period:** 2023-09-30 → 2027-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10828499

## Citation

> US National Institutes of Health, RePORTER application 10828499, Improving Diagnostic Safety through STeatosis Identification, Risk stratification, and Referral in the ED (STIRRED) (1R01HS029777-01). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10828499. Licensed CC0.

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