Aligning with Obesity Guidelines: A Quality Improvement Initiative in Pediatric Primary Care

Abstract

Objective: National guidelines recommend diagnosis of obesity on the basis of body mass index starting at age 2 years and screening for specific comorbidities based on age and risk factors. A multimodal intervention was developed and quality improvement (QI) methodology was used to assess the effectiveness of different interventions on pediatric primary care clinician's adherence to evidence-based clinical guidelines. Study design: A multidisciplinary team was engaged to develop an institutional weight management and diet-related disease toolkit to standardize practice through a QI initiative. This initiative included an educational series, coaching sessions for a subset of providers, and automating electronic medical record (EMR) changes to support adherence to the clinical toolkit. We staggered the interventions to assess for behavior change related to clinical documentation and laboratory test ordering practices. Results: Baseline data showed significant differences between individual clinicians’ practices. Educational initiatives increased the use of diagnostic obesity codes from a baseline of 75% of charts. Initially, International Classification of Diseases, Tenth Revision, codes for nutrition and physical activity counseling were underused and remained low despite education interventions. EMR prompts and templates led to a significant and sustained increase in coding. A statistically significant decrease in overall extraneous laboratory test collection was noted but inconsistencies in laboratory test collection persisted. Conclusions: This QI initiative aimed to standardize clinicians’ behavior around EMR documentation. A multimodal intervention was able to improve documentation of weight status and counseling measures to >80% of well child check encounters. Future studies are encouraged to investigate whether these changes led to improved patient outcomes.

Keywords

• pediatric obesity guidelines
• childhood obesity
• quality improvement
• value-based care