Introduction: Non-alcoholic steatohepatitis (NASH) is becoming pandemic. The management of this chronic liver disease is often frustrating. Here, we undertake a quality improvement project to explore potential gaps in NASH management within our clinical practice. Methods: In our tertiary care teaching hospital, new NASH patients in the gastroenterology (GI) clinic from April 1st, 2010 to June 30th, 2011 were reviewed. They were seen by 2 types of providers: those with a mixed GI/hepatology background (mixed GI), or those with purely hepatology background (hepatology). The patients were followed over the next 3 years. Demographics, patient characteristics, labs such as AST, ALT, platelet, etc., and relevant medications were recorded. The number of clinic visits was counted. NAFLD fibrosis scores (FS) were calculated from the initial visit and the patients were then identified as low (FS <-1.455), intermediate (FS -1.455 to 0.676), and high risk (FS>0.676). Results: During the 14 months from April 1st, 2010 to June 30th, 2011, a total of 72 and 65 new NASH patients were seen by hepatology and mix GI providers, respectively. About half of the patients were male. Median age was 54.6 and 49.3, respectively. According to NAFLD FS, the majority are at least of intermediate risk (77.7 and 57.4%, respectively). Most had dyslipidemia (76.4% and 81%, respectively); however, only 46% in mixed GI practice are on statins compared to 69% in pure hepatology practice. 69.4% checked for fasting insulin in the pure hepatology practice, while only 13.8% did so the mixed GI practice. 72.2% were on Vitamin E in the hepatology practice, compared to 31.1% in mixed GI practice. Fifty percent were seen in the GI clinic for 3 or more times in the 3-year period in the hepatology practice, compared to only 27% with mixed GI. Furthermore, 76.4% and 99% were checked for HAV and HBV immunity in the hepatology practice, while only 41.5% and 23% in the mixed GI practice. Finally, a relatively small number had a liver biopsy (18.1% and 23%, respectively, in the pure hepatology versus mixed GI practice). Conclusion: NASH patients who are referred to the GI clinic in a tertiary teaching hospital are mostly of high risk according to NAFLD fibrosis scores. In general, these patients did not get satisfactory long-term care for the chronic steatohepatitis. The appropriate use of vitamin E and statins is suboptimal, especially among the providers with a mixed GI population. A more standardized care model might help close the gaps and improve quality of care in the NASH patient population.