Previous innovation projects

The Scarred Liver Project

The EMAHSN Scarred Liver project supported the development of a community based liver diagnostic pathway which has proven to more effectively detect chronic liver disease at an early stage, increasing the chances of halting further deterioration or reversing the impact.

The pathway combines the identification of patients at risk (as a result of their lifestyle) with a non-invasive diagnostic test using a Fibroscan® - a mobile scanner that highlights liver scarring.

EMAHSN worked with multiple partners including Nottingham University Hospitals and Chesterfield Royal Hospital to support the implementation into various sites across the East Midlands.

 Solutions / actions taken 

Working in partnership with the NIHR Nottingham Digestive Diseases Centre Biomedical Research Unit, supported the implementation of the innovation at sites across Nottingham and Derbyshire. 

The pathway has supported the identification of patients much earlier, with the ultimate aim of halting the condition or dramatically improving patient outcomes, as compared with current processes, which often lead to patients not being identified early enough for effective treatment. It has undergone a full health economic evaluation and attracted interest from regional clinical commissioning groups (CCGs), which included the team facilitating the redesign of the adult liver disease stratification pathway in one locality.

The EMAHSN has supported this project since 2013 and have supported the roll out of the pathway across multiple settings with differing socio-economic characteristics, and provided specialist expertise to support adoption and spread of the pathway into clinical practice. This includes health economics and translational research expertise which has informed the development of commissioning cases with local CCGs.

The pathway across Nottingham and Nottinghamshire is now an established clinical approach and has been commissioned across Greater Nottingham and Nottingham City Integrated Care Partnerships. 

Impacts and outcomes from the project 

Overall the project has been successful in the implementation of Fibroscan® in previously unexplored pathways and accessing new networks. The project has achieved significant levels of activity within the East Midlands. Overall the project has been successful in the implementation of Fibroscan® in previously unexplored pathways and accessing new networks. In summary, some of the impacts have been:

  • The pathway is now accessible to more than 100 GPs in the East Midlands, serving a population of approximately 700,000 people
  • Research following intervention suggests that Fibroscan® triggers a recognition about the need to change lifestyle behaviour, with 32% of patients (who consented to be followed up, had baseline data and were contactable) losing at least 5% of their baseline body weight and 29% reducing their alcohol intake by 10%.

Lifestyle behaviour impacts include:

Reduced alcohol use –  A statistically significant reduction in alcohol use was reported from baseline to three and 12 months, with alcohol use reducing by an average of 10 units per week across the sample.

Weight loss – A statistically significant reduction in weight was observed from baseline to three and 12 months, with an average of 1.1kg and 1.6kg of weight lost at three and 12 months, respectively.

Scarred Liver Project resources