A QI INTERVENTION IN A RESIDENT PRIMARY CARE CLINIC TO IMPROVE RECOGNITION AND TREATMENT OF OVERWEIGHT AND OBESE CHILDREN

Carly Scahill DO, Talia Glasberg MD, Molly Beleckis MD, Justin Ruoss MD, Kristina Gustafson MD MSCR, Annie Andrews MD MSCR

BACK-GROUND1 in 3 children in the US are

overweight or obese (CDC 2010)80% of children who were overweight

at age 10-15 were obese by age 25 (CDC 2010)

PLAN Assessing the current situation Trying to determine why there is a problem Coming up with a solution for improvement

PLAN – ASSESS CURRENT SITUATION

Assess our current situation and need for improvementDetermining if overweight/obesity is a problem

Prevalence of Overweight/Obese = 32.5%

PLAN – ASSESS CURRENT SITUATION Determine if we need improvement with diagnosing

and treating this population 2007 AAP- consensus statement regarding guidelines

for diagnosing and treating overweight and obese children Diagnosing BMI Percentile

Overweight BMI 85th%- 94th% Obese BMI > 95th%

Treatment and Prevention In office counseling

5-2-1-0 Rule Every 2 year screening labs on patient >10yo

Lipids, AST, ALT, Blood glucose Follow up every week to 3 months Referral when necessary

PLAN – ASSESS CURRENT SITUATION

Retrospective chart review – well child checks 2010 (N=100 overweight, N=100 obese)

Obesity/Overweight Diagnosing 35% / 0% Counseling 42% / 4% F/U < 1 year 53% / 35% Lipids 38% / 8% AST/ALT 38% / 5% Blood glucose 25% / 3% Referrals 12% / 2%

PLAN – DETERMINING WHY THERE IS A PROBLEM

Lack of understanding the AAP recommendations Difficulty determining BMI% with current system Simply forgetting

PLAN – COMING UP WITH SOLUTION

ObjectiveTo improve identification and treatment of our overweight and obese patients

1st – solutionAutomatically calculate BMI %Reminder in WCC template

Low tech, low cost intervention, easily adaptable

DO - INTERVENTION

Educating physicians Placing reminders at physician work stations BMI cutoff value postings

DO- INTERVENTION

AAP Treatment Guideline postings

DO - INTERVENTION

Easily accessible weight counseling resources

DO - INTERVENTION

STUDY AND ACT Monthly retrospective chart reviews -

Outcome variablesDocumentation/Diagnosing obesity/overweightWeight loss counselingReferralsScreening labs recommended by AAPFollow up appointment <1 year

RESULTS – PROGRESS FOR OBESE PATIENTS

RESULTS – PROGRESS FOR OVERWEIGHT PATIENTS

CONCLUSION

Through implementation of a low tech, low cost obesity intervention we have seen substantial improvement in recognizing our overweight and obese patients and improved rates of weight counseling, appropriate screening labs ordered, and more frequent follow-up

FUTURE DIRECTION

Place more of a focus on improving the diagnosis and treatment of our overweight population

Determine if our improved diagnosis and treatment is actually decreasing the prevalence of overweight and obesity in our clinic

Take our intervention to the next step with changes in EMR