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Krueger H, Robinson S, Hancock T, Birtwhistle R, Buxton JA, Henry B, Scarr J, Spinelli JJ. Priorities among effective clinical preventive services in British Columbia, Canada. BMC Health Serv Res 2022; 22:564. [PMID: 35473549 PMCID: PMC9044882 DOI: 10.1186/s12913-022-07871-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 03/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Despite the long-standing experience of rating the evidence for clinical preventive services, the delivery of effective clinical preventive services in Canada and elsewhere is less than optimal. We outline an approach used in British Columbia to assist in determining which effective clinical preventive services are worth doing. Methods We calculated the clinically preventable burden and cost-effectiveness for 28 clinical preventive services that received a ‘strong or conditional (weak) recommendation for’ by the Canadian Task Force on Preventive Health Care or an ‘A’ or ‘B’ rating by the United States Preventive Services Task Force. Clinically preventable burden is the total quality adjusted life years that could be gained if the clinical preventive services were delivered at recommended intervals to a British Columbia birth cohort of 40,000 individuals over the years of life that the service is recommended. Cost-effectiveness is the net cost per quality adjusted life year gained. Results Clinical preventive services with the highest population impact and best value for money include services that address tobacco use in adolescents and adults, exclusive breastfeeding, and screening for hypertension and other cardiovascular disease risk factors followed by appropriate pharmaceutical treatment. In addition, alcohol misuse screening and brief counseling, one-time screening for hepatitis C virus infection in British Columbia adults born between 1945 and 1965, and screening for type 2 diabetes approach these high-value clinical preventive services. Conclusions These results enable policy makers to say with some confidence what preventive manoeuvres are worth doing but further work is required to determine the best way to deliver these services to all those eligible and to establish what supportive services are required. After all, if a clinical preventive service is worth doing, it is worth doing well.
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Affiliation(s)
- Hans Krueger
- H. Krueger & Associates Inc., Delta, Canada. .,School of Population and Public Health, University of British Columbia, Vancouver, Canada.
| | | | - Trevor Hancock
- School of Public Health and Social Policy, University of Victoria, Victoria, Canada
| | - Richard Birtwhistle
- Department of Family Medicine and Public Health Sciences, Queen's University, Kingston, Canada.,Canadian Task Force on Preventive Health Care, Ottawa, Canada
| | - Jane A Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.,BC Center for Disease Control, Vancouver, Canada
| | - Bonnie Henry
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.,BC Ministry of Health, Victoria, Canada
| | - Jennifer Scarr
- Child Health BC, Provincial Health Services Authority, Vancouver, Canada
| | - John J Spinelli
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
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Eisenberg D, LaVela SL, Frayne SM, Chen R, Barreto NB, Wu J, Nevedal AL, Davis K, Arnow KD, Harris AH. Rates, Variability, and Predictors of Screening for Obesity: Are Individuals with Spinal Cord Injury Being Overlooked? Obes Facts 2022; 15:451-457. [PMID: 35263742 PMCID: PMC9209967 DOI: 10.1159/000523917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/24/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Individuals with spinal cord injury (SCI) are vulnerable to obesity. Annual obesity screening using body mass index (BMI) is the standard of care mandated by US Veterans Health Administration (VHA) guidelines. Our objective was to determine the rates, variability, and predictors of guideline-concordant annual screening for obesity, given potential challenges of height and weight measurements in individuals with SCI. METHODS This is a cross-sectional retrospective study using US national VA databases. We identified all VHA patients with chronic SCI in the fiscal year (FY) 2019, their treating facility and frequency of recorded height and weight. We applied mixed-effects logistic regression models to assess associations between annual BMI screening and patient- and facility-level characteristics. RESULTS Of 20,978 individuals with chronic SCI in VHA in FY19, guideline-concordant annual BMI screening was lacking in 37.9%. Accounting for facility-level factors (geographic region, SCI facility type, volume of patients with SCI treated at the facility), a mixed-effects logistic regression model demonstrated that lack of annual obesity screening was significantly associated with older patient age (p < 0.001) and fewer outpatient encounters (p < 0.001) but not other patient-level factors such as sex, race, level of injury, or rurality. The rate of obesity screening among different facilities within VHA varied widely from 11.1% to 75.7%. CONCLUSION A large proportion of persons with SCI receiving care in VHA do not receive guideline-concordant annual obesity screening, an especially acute problem in some facilities. Older patients with fewer outpatient encounters are more likely to be missed. To inform the design of interventions to improve identification and documentation of obesity, further study is needed to assess potential barriers to obesity screening in the population with SCI.
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Affiliation(s)
- Dan Eisenberg
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford School of Medicine, Stanford, California, USA
- *Dan Eisenberg,
| | - Sherri L. LaVela
- Center of Innovation for Complex Chronic Care, VA Edward Hines Jr., Hines, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Susan M. Frayne
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA
- Department of Medicine, Stanford School of Medicine, Stanford, California, USA
| | - Rui Chen
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford School of Medicine, Stanford, California, USA
| | - Nicolas B. Barreto
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford School of Medicine, Stanford, California, USA
| | - Justina Wu
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Andrea L. Nevedal
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Kristen Davis
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford School of Medicine, Stanford, California, USA
| | - Katherine D. Arnow
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford School of Medicine, Stanford, California, USA
| | - Alex H.S. Harris
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford School of Medicine, Stanford, California, USA
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Abstract
INTRODUCTION With increased survival, children with CHD are reaching adulthood, however, obesity amongst this cohort is an emerging problem. Making every contact count encourages clinicians to utilise contact to elicit behaviour change. The aim of this work was to identify whether the body habitus of children classified as obese was addressed during a clinical review. METHODS A retrospective observational cohort study was completed using a cardiology outpatient dataset from 2010 to 2019. Inclusion criteria are all children with a body mass index z score classified as obese (≥ 2 z scores). Individual electronic patient records were reviewed to identify long-term anthropometric measures including (i) recognition of body habitus, (ii) prescription of physical activity or dietary intervention, and (iii) referral to a weight management programme or dietitian. RESULTS From the cohort of 95 patients, 285 "obese clinical encounters" were identified, at the time of a cardiology clinic attendance. Of those, obesity was acknowledged in 25 clinic letters (8.65%), but only 8 used the correct terms "obese" or "obesity" (2.77%). Action to tackle obesity was recorded in 9.3% of cases with a direct referral to a dietitian being made on 3 occasions (1.04%). CONCLUSIONS Body habitus is not being routinely addressed by cardiologists caring for paediatric and young adult cardiac patients. This study has recognised an alarmingly high incidence of missed opportunities to make every contact count, to manage those with obesity and associated risk factors.
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Kharofa RY, Khalsa AS, Zeller MH, Modi AC, Ollberding NJ, Copeland KA. Giving "prescriptions" for paediatric weight management follow-up in primary care. Clin Obes 2021; 11:e12448. [PMID: 33733574 DOI: 10.1111/cob.12448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 02/04/2021] [Accepted: 02/12/2021] [Indexed: 12/01/2022]
Abstract
The American Academy of Paediatrics recommends that primary care paediatricians "prescribe" follow-up for weight management between well child checks. We sought to describe rates and predictors of prescribed and actual clinic attendance for weight management in primary care in a predominantly low-income population. A chart review was performed at a large, hospital-based, primary care clinic, where a treatment algorithm for obesity exists. Eligible children were 6 to 12 years of age with a body mass index (BMI) ≥85th percentile and seen for a well child check in 2014. Primary outcomes were the physician prescribing follow-up in primary care and the patient returning for weight management. Multivariable logistic regression was used to identify predictors of prescribing follow-up and predictors of return. Participants included 1339 patients: mean age 9 years (SD: 1.8 years); 53% female; 79% Black; 89% Medicaid-insured; 56% with an obese BMI (vs overweight). Twenty-seven percent of patients were prescribed follow-up in primary care, of which 13% returned (only 4% of the original sample). The odds of the physician prescribing follow-up were greater if the child had obesity (vs overweight), was older, female or non-Medicaid insured. Older and non-Black patients had greater odds of returning. Patients prescribed follow-up within 2 months or less (vs 3-6 months) were also more likely to return (aOR 2.66; CI: 1.34, 5.26). Rates of prescription for weight management in primary care are low and few patients return, even when follow-up is prescribed. Prescribing follow-up at shorter intervals from the index visit (≤ 2 months) may improve patient return.
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Affiliation(s)
- Roohi Y Kharofa
- Centre for Better Health and Nutrition, The Heart Institute, Cincinnati Children's Hospital Medical Centre, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Amrik Singh Khalsa
- Division of Primary Care Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Meg H Zeller
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Centre for Child Behavior and Nutrition Research and Training, Cincinnati Children's Hospital Medical Centre, Cincinnati, Ohio, USA
| | - Avani C Modi
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Centre for Adherence and Self-Management, Cincinnati Children's Hospital Medical Centre, Cincinnati, Ohio, USA
| | - Nicholas J Ollberding
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Centre, Cincinnati, Ohio, USA
| | - Kristen A Copeland
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Centre, Cincinnati, Ohio, USA
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Wang'ondu R, Vitale R, Rosenblum H, Pinto-Taylor E, Grossman M, Sharifi M, Gielissen K, Doolittle B. A resident-led project to improve documentation of overweight and obesity in a primary care clinic. J Community Hosp Intern Med Perspect 2019; 9:377-383. [PMID: 31723380 PMCID: PMC6830187 DOI: 10.1080/20009666.2019.1681056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 09/23/2019] [Indexed: 11/04/2022] Open
Abstract
Background: Although the prevalence of overweight and obesity (OW/OB) has
increased in the last three decades, studies show that these conditions are sub-optimally
documented by physicians. Health information technology tools have varying effects on
improving documentation of OW/OB but often have to be complemented with other
interventions to be effective. Objective: Upon identifying low rates of documentation of diagnoses of
overweight and obesity by resident and attending physicians, despite the use of an
electronic health record (EHR) with automated BMI calculations, we performed a quality
improvement (QI) project to improve documentation of these diagnoses for patients in our
community hospital primary care clinic. Methods: The EHR was reviewed to determine documentation rates by resident
and attending physicians between 1 March 2018 and 31 September 2018. We collected
pre-intervention data, developed interventions, and implemented tests of change using
Plan-Do-Study-Act (PDSA) cycles to improve documentation of OW/OB. Results: Documentation of overweight and obesity diagnoses increased from a
baseline of 46% to 79% over a 20-week period after initiation of our project. Conclusion: We demonstrate the successful implementation of resident-led,
multi-faceted interventions in a team-based QI project to optimize documentation of OW/OB
in the EHR.
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Affiliation(s)
- Ruth Wang'ondu
- Departments of Internal Medicine and Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Rebecca Vitale
- Departments of Internal Medicine and Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Hannah Rosenblum
- Departments of Internal Medicine and Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Emily Pinto-Taylor
- Departments of Internal Medicine and Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Matthew Grossman
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Mona Sharifi
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Katherine Gielissen
- Departments of Internal Medicine and Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Benjamin Doolittle
- Departments of Internal Medicine and Pediatrics, Yale University School of Medicine, New Haven, CT, USA.,Departments of General Medicine, Yale University School of Medicine, New Haven, CT, USA
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Nasim M, Aldamry M, Omair A, AlBuhairan F. Identifying obesity/overweight status in children and adolescents; A cross-sectional medical record review of physicians' weight screening practice in outpatient clinics, Saudi Arabia. PLoS One 2019; 14:e0215697. [PMID: 31022236 PMCID: PMC6483234 DOI: 10.1371/journal.pone.0215697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 04/05/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND BMI is a feasible and recommended measure for overweight and obesity screening in children and adolescents. The study aimed to determine how often physicians correctly identified obesity/ overweight status in children and adolescents by using BMI percentile charts. METHODS This retrospective cross-sectional study reviewed the paper medical records of children and adolescents (6-14 years) who visited family medicine and pediatric outpatient clinics (Jan-June 2012) in a medical city in Riyadh. Investigators calculated BMI percentiles (using height, weight, age and gender data retrieved from the records) in order to identify patient weight status. Physician documentation of obesity/overweight diagnoses in patient problem lists were cross checked against their BMI percentile to assess the accuracy of physicians' identification of weight status. The recommended management plan for identified patients was also recorded. RESULTS A total of 481 charts were reviewed, 213 (44%) children were seen by family medicine physicians and 268 (56%) by pediatricians. The sample was equally distributed by gender. Height was undocumented for 13% (71) of visiting patients. Eighteen percent of patients (86) were classified as overweight (35)/obese (51) according to age and sex adjusted BMI percentile. Physicians' correctly identified and documented weight status in 20% of overweight/obese patients: 17 out of 86 subjects. Weight status identification was higher among pediatricians-25% as compared to family medicine physicians-10% [p = 0.08]. Dietary referral was the most common management plan for the identified children. Physicians were more likely to identify obese children {≥95th} compared to overweight {≥85th - 95th} children. Subjects whose BMI for age classified them into the highest BMI percentile category {≥95th} were more likely to be correctly identified (29%) compared to those classified within {≥85th - 95th} category-6% [p = 0.007]. CONCLUSION Physician identification of obesity/ overweight status for children and adolescents was low, irrespective of their specialty, and despite the condition being prevalent in the sample. Future research that concentrates on interventions that may improve documentation of obesity/overweight diagnoses and parameters needed for BMI indices would be beneficial.
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Affiliation(s)
- Maliha Nasim
- Department of Population Health, King Abdullah International Medical Research Center/ King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Department of Medical Education, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammed Aldamry
- Department of Medical Education, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Aamir Omair
- Department of Medical Education, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Fadia AlBuhairan
- Department of Pediatrics and Adolescent Medicine, Aldara Hospital and Medical Center, Riyadh, Saudi Arabia
- John Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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7
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Morais A, Kelly J, Bost JE, Vaidya SS. Characteristics of Correctly Identified Pediatric Obesity and Overweight Status and Management in an Academic General Pediatric Clinic. Clin Pediatr (Phila) 2018. [PMID: 29514514 DOI: 10.1177/0009922818761891] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study identified and characterized the rates of documentation and guideline-based management of overweight and obese children within an academic pediatric clinic through a retrospective electronic medical record review of 7422 well-child visits in 2016. Diagnosis and treatment were analyzed by patient's weight diagnosis, sex, age, and provider training level. The percentages of correctly identified severely obese (90.2%), obese (77.0%), and overweight (42.0%) children were much higher than in previous retrospective chart reviews; however, less than 30% of children were referred for more intensive weight management to a dietitian or pediatric obesity weight management program. Increased provider training level was associated with a lower adherence to pediatric obesity guidelines. Strategic modifications to electronic medical records that automatically offer body mass index-associated weight diagnoses with a link to treatment pathways and resources are needed to facilitate improved compliance with current pediatric obesity guidelines in the primary care setting.
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Affiliation(s)
- Ana Morais
- 1 George Washington University, Washington, DC, USA
| | - Joseph Kelly
- 2 Children's National Health System, Washington, DC, USA
| | - James E Bost
- 2 Children's National Health System, Washington, DC, USA
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8
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Gohil A, James S, Rahhal S. Clinical Versus Objective Assessment of Overweight and Obese Children Among Primary Care Physicians. Glob Pediatr Health 2017; 4:2333794X17719204. [PMID: 28812055 PMCID: PMC5528948 DOI: 10.1177/2333794x17719204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 05/30/2017] [Indexed: 11/17/2022] Open
Affiliation(s)
- Anisha Gohil
- St. Vincent Hospital and Health Care Center, Indianapolis, IN, USA
| | - Shannon James
- St. Vincent Hospital and Health Care Center, Indianapolis, IN, USA
| | - Samar Rahhal
- St. Vincent Hospital and Health Care Center, Indianapolis, IN, USA
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9
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Thaker VV, Lee F, Bottino CJ, Perry CL, Holm IA, Hirschhorn JN, Osganian SK. Impact of an Electronic Template on Documentation of Obesity in a Primary Care Clinic. Clin Pediatr (Phila) 2016; 55:1152-9. [PMID: 26676994 PMCID: PMC4909579 DOI: 10.1177/0009922815621331] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Identification of obesity at well-child care (WCC) examinations is a step toward intervention. Studies have shown suboptimal documentation in primary care clinics that can improve with the use of electronic health records (EHRs). This study investigated the impact of a standardized EHR template on documentation of obesity at WCC visits and its impact on physician behavior. A cohort of 585 children with severe early onset obesity (body mass index >99th percentile, age <6 years) was identified with an electronic algorithm. Complete records of visit notes were reviewed to extract history taking, counseling, and recording of obesity at a WCC visit. Use of a standardized EHR template for WCC visits is associated with improvement in rates of documentation of obesity (47% vs 34%, P < .01), without interruption of workflow. Documentation of obesity in the chart improved nutritional (66% vs 44%, P < .001) and physical activity counseling (23% vs 9%, P < .001).
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Affiliation(s)
| | - Felix Lee
- Project Success, The Office of Diversity and Community Inclusion, Harvard Medical School, Boston MA
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10
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Higgins A, McCarville M, Kurowski J, McEwen S, Tanz RR. Diagnosis and Screening of Overweight and Obese Children in a Resident Continuity Clinic. Glob Pediatr Health 2014; 1:2333794X14559396. [PMID: 27335918 PMCID: PMC4804692 DOI: 10.1177/2333794x14559396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective. To evaluate the association between documenting excess weight and ordering screening tests. Methods. We retrospectively reviewed well-child visits for patients 2 to 18 years old at a pediatric resident clinic. We evaluated visits of patients with body mass index ≥ 85th percentile for documentation of excess weight in the electronic medical record (EMR) and screening tests ordered. Associations were investigated with χ2 tests. Results. Of 522 patients, 215 (41%) were overweight (19%) or obese (22%). Among obese and overweight patients, 92/215 (43%) had documentation of excess weight in the EMR. Screening tests were ordered for 39/92 (42%) patients with a diagnosis of excess weight versus 8/123 (6.5%) of those without one (P < .001). Conclusions. Documentation rates of excess weight by practitioners were low and worse for younger children and those with milder degrees of excess weight. Documenting excess weight in the EMR was highly associated with ordering of screening tests.
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Affiliation(s)
- Alanna Higgins
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Jacob Kurowski
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Scott McEwen
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Robert R Tanz
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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11
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Cygan HR, Baldwin K, Chehab LG, Rodriguez NA, Zenk SN. Six to success: improving primary care management of pediatric overweight and obesity. J Pediatr Health Care 2014; 28:429-37. [PMID: 24725517 DOI: 10.1016/j.pedhc.2014.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 01/29/2014] [Accepted: 02/05/2014] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Despite the existence of established guidelines addressing pediatric obesity, many primary care providers fail to successfully implement recommendations. This study measured the impact of Six to Success, a weight management program based on the Chronic Care Model, on primary care provider adherence to pediatric weight management guidelines. METHOD We used comprehensive pre- and postimplementation chart audits (N = 396) to conduct a quality improvement study at a hospital-based pediatric outpatient clinic. Charts of patients with a body mass index percentile at or above the 85th percentile (preimplementation, n = 90; postimplementation, n = 97) were audited for 23 identification, assessment, and prevention measures recommended in the care of the pediatric overweight/obese patient. RESULTS Statistically significant improvements to clinical guideline adherence were found in the following areas: correct diagnosis, physical examination, lifestyle assessment, use of motivational interviewing, and prevention strategies. DISCUSSION These findings suggest that Six to Success can be an effective method of improving primary care provider adherence to established pediatric weight management guidelines.
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12
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Walker DM, Robbins JM, Brown D, Berhane Z. Improving processes of care for overweight and obese children: evidence from the 215-GO! program in Philadelphia health centers. Public Health Rep 2014; 129:303-10. [PMID: 24791028 DOI: 10.1177/003335491412900314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Daniel M Walker
- Daniel Walker is a Doctoral Candidate with the Tulane School of Public Health and Tropical Medicine in New Orleans, Louisiana. Jessica Robbins is an Epidemiologist with the PDPH and an Adjunct Assistant Professor at the Drexel School of Public Health, both in Philadelphia, Pennsylvania. Darryl Brown and Zekarias Berhane are Assistant Professors with the Drexel School of Public Health
| | - Jessica M Robbins
- Daniel Walker is a Doctoral Candidate with the Tulane School of Public Health and Tropical Medicine in New Orleans, Louisiana. Jessica Robbins is an Epidemiologist with the PDPH and an Adjunct Assistant Professor at the Drexel School of Public Health, both in Philadelphia, Pennsylvania. Darryl Brown and Zekarias Berhane are Assistant Professors with the Drexel School of Public Health
| | - Darryl Brown
- Daniel Walker is a Doctoral Candidate with the Tulane School of Public Health and Tropical Medicine in New Orleans, Louisiana. Jessica Robbins is an Epidemiologist with the PDPH and an Adjunct Assistant Professor at the Drexel School of Public Health, both in Philadelphia, Pennsylvania. Darryl Brown and Zekarias Berhane are Assistant Professors with the Drexel School of Public Health
| | - Zekarias Berhane
- Daniel Walker is a Doctoral Candidate with the Tulane School of Public Health and Tropical Medicine in New Orleans, Louisiana. Jessica Robbins is an Epidemiologist with the PDPH and an Adjunct Assistant Professor at the Drexel School of Public Health, both in Philadelphia, Pennsylvania. Darryl Brown and Zekarias Berhane are Assistant Professors with the Drexel School of Public Health
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13
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Rossen LM, Tarasenko YN, Branum AM, Simon AE, Schoendorf KC. Abdominal adiposity and caregiver recall of healthcare provider identification of child overweight in the United States, 2001-2010. Child Obes 2013; 9:418-26. [PMID: 24028562 PMCID: PMC4655875 DOI: 10.1089/chi.2013.0051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND A minority of overweight or obese children are identified as such by a healthcare provider (HCP). The aim of this study was to examine characteristics of caregiver-reported HCP identification of overweight or obesity and whether it is associated with children's waist circumference (WC). METHODS This was an observational study using a nationally representative sample of 14,694 children (2-15 years of age) from the 2001-2010 National Health and Nutrition Examination Survey. Proxy respondents (i.e., caregivers) for 4906 overweight or obese (BMI≥85th percentile) children reported whether an HCP had ever told them that their child was overweight. Multi-variable logistic regression analyses were used to examine associations between reported HCP identification of overweight and child sociodemographic and anthropometric characteristics. RESULTS Over 75% of caregivers of overweight or obese children did not recall being notified of their child's weight status by an HCP, though this proportion has decreased over the past decade. A significant WC by weight status interaction indicated abdominal adiposity was positively associated with reported HCP identification for obese children, but not for overweight children. CONCLUSIONS Lower levels of reported HCP identification were observed for overweight children, compared to obese children; among obese children, those with lower levels of abdominal adiposity were less likely to be identified as overweight by an HCP, according to caregivers. Reasons for this finding remain unclear. Providers may be relying on a child's appearance, rather than universally screening all patients for overweight. Additionally, a variety of parent and provider characteristics may influence weight-related communications and caregiver recall of such information.
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Affiliation(s)
- Lauren M. Rossen
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD
| | - Yelena N. Tarasenko
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD,Department of Health Policy and Management and the Department of Epidemiology, Georgia Southern University, Jiann-Ping Hsu College of Public Health, Statesboro, GA
| | - Amy M. Branum
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD
| | - Alan E. Simon
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD
| | - Kenneth C. Schoendorf
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD
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14
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Schwiebbe L, Talma H, van Mil EG, Fetter WPF, Hirasing RA, Renders CM. Diagnostic procedures and treatment of childhood obesity by pediatricians: 'The Dutch approach'. Health Policy 2013; 111:110-5. [PMID: 23683472 DOI: 10.1016/j.healthpol.2013.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 03/22/2013] [Accepted: 04/09/2013] [Indexed: 11/24/2022]
Abstract
Child Public Health professionals in the Netherlands refer obese children to a pediatrician to check for underlying causes and comorbidity. What happens to these children in terms of diagnostics and treatment when they visit a pediatrician? To get an overview of the diagnostic procedures and treatment methods a questionnaire was developed and sent to all 583 pediatricians in the Netherlands. Data was obtained of 290 pediatricians from 85% of the general hospitals and all (8) academic hospitals. To define childhood obesity Dutch pediatricians most often use the adult Body Mass Index, only 34% use the sex and age specific IOTF-BMI-criteria. 11% of the (non-obese) overweight children visiting a pediatrician have already comorbidities. All pediatricians perform at least weight and height measurements. Waist circumference is measured by only 42%, ninety-five percent measure blood pressure. To treat obese children without comorbidity thirty different intervention programs were reported. A large variation in diagnostics and interventions of childhood obesity exist. Guidelines in pediatric obesity for diagnostics and treatment are urgently needed.
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Affiliation(s)
- Luuk Schwiebbe
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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Perrin EM, Skinner AC, Steiner MJ. Parental recall of doctor communication of weight status: national trends from 1999 through 2008. ACTA ACUST UNITED AC 2011; 166:317-22. [PMID: 22147758 DOI: 10.1001/archpediatrics.2011.1135] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To examine time trends in parental reports of health professional notification of childhood overweight over the last decade and to determine the characteristics most associated with such notification. DESIGN Secondary data analysis using χ(2) tests to examine the relationships between multiple factors on the reports of parents and/or caregivers (hereinafter "parents") and logistic regression for multivariate analysis. SETTING National Health and Nutrition Examination Survey, 1999 through 2008. PARTICIPANTS Parents of 4985 children aged 2 to 15 years with body mass index (BMI) in the 85th percentile or higher based on measured height and weight. MAIN OUTCOME MEASURES Affirmative answer to the following question: "Has a doctor or health professional ever told you that your child is overweight?" RESULTS During 1999 through 2008, 22% of parents of children with BMIs in the 85th percentile or higher reported having been told by a doctor or health professional that their child was overweight; recall of notification was actually more likely among nonwhite and poor children. This percentage increased from 19.4% to 23.2% from the 1999-2004 period and further accelerated in the 2007-2008 period to 29.1%. The time trend persisted in multivariate analyses, with significantly more parents reporting having been told in 2007 through 2008 than in 1999 through 2000. CONCLUSION Fewer than one-quarter of parents of overweight children report having been told that their child was overweight. While reports of notification have increased over the last decade (perhaps because of [1] revised definitions of overweight and obesity, [2] increased concern about children with BMIs in the 85th to 95th sex- and age-specific percentiles, or [3] improved recall by parents), further research is necessary to determine where and why communication of weight status breaks down.
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Affiliation(s)
- Eliana M Perrin
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, 231 MacNider Hall, Chapel Hill, NC 27599-7225, USA.
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Looney SM, Spence ML, Raynor HA. Use of body mass index and body mass index growth charts for assessment of childhood weight status in the United States: a systematic review. Clin Pediatr (Phila) 2011; 50:91-9. [PMID: 20837615 DOI: 10.1177/0009922810379911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Shannon M Looney
- Department of Nutrition,University of Tennessee, 1215 W. Cumberland Avenue, Knoxville, TN 37996-1920, USA.
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