Losing weights: Failure to recognize and act on weight loss documented in an electronic health record

Abstract

Background: Involuntary weight loss is associated with higher mortality. When this weight loss is unrecognized, opportunities for timely diagnosis of significant conditions may be missed. Objective:To use electronic health record (EHR) data to estimate the frequency of unrecognized involuntary weight loss and its implications. Methods: We performed a retrospective analysis of the weights recorded in an EHR of 100,000 adult patients seen in outpatient clinics over a five-year period using a novel data visualization and review tool. We reviewed charts of a random sample of 170 patients experiencing weight loss periods. Our outcomes included determinations of whether weight loss 1) was voluntary vs. involuntary; 2) was recognized and documented; and 3) possible explanations identifiable at the index visit or within the subsequent two years. Results: Of 170 randomly-selected weight loss periods reviewed, 22 (13%) were involuntary, 36 (21%) were voluntary and 112 (66%) were indeterminate. Sixty-six (39%) weight loss periods were recognized by clinician at the index visits and an additional 3 (1%) at the next PCP visits. Possible explanations for weight loss emerged in the subsequent two years including medical conditions in 60 (45%), psycho-social conditions in 19 (14%), erroneous data entry in 9 (7%), voluntary weight loss in 8 (6%), and postpartum weight loss in 6 (4%). No possible explanations were found in 32 (24%). Conclusions:Periods of weight loss were common, often involuntary and frequently not recognized or documented. Many patients with involuntary weight loss had potential explanations that emerged within the subsequent two years.

Keywords

• weight loss
• diagnostic errors
• delayed diagnosis
• medical errors
• electronic health records