A Team-based Approach Using an Electronic Registry to Increase Patient-Centered Goal Setting in Obesity Management

• Published in: Pediatrics (Evanston) 2019-08, Vol.144 (2_MeetingAbstract), p.217-217
• Main Authors: Jain, Sanjeev, Allen, Gail S., Pletta, Karen, Kerr, Bradley, Moreno, Megan
• Format: Article
• Language: English
• Subjects: Adolescents; Body mass; Body mass index; Chronic conditions; Chronic illnesses; Disease management; Electronic health records; Electronic medical records; Health risks; Internet; Medical personnel; Nurses; Obesity; Patients; Pediatrics; Primary care; Quality control; Weight control
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.144.2MA3.217

Background: Obesity affects approximately 17% of U.S. children and adolescents, threatening their health and longevity. Motivational Interviewing (MI) using patient-centered goals can be an effective clinical strategy for managing obesity, but it is difficult to incorporate and track in busy primary care settings. Electronic Health Records (EHR) have potential to improve process and documentation for patients with obesity. Purpose: This QI project investigates whether a team-based approach using EHR can increase patient-centered goal setting in pediatric patients with obesity. Methods: We created workflows to be used in primary care setting using the PDCA process (Plan, Do, Check, Act) and creating an A3 (Specific Aim, Fishbone diagram, Process Improvement Step, Process Measurement). An electronic patient registry for obesity, populated by EHR data including body mass index (BMI), was created. Obesity is defined as BMI ≥ 95th percentile. Nurses used the registry to identify and contact patients with obesity and encourage yearly well-child checks. Clinical staff was encouraged to update the EHR problem list to document BMI at each patient encounter. All physicians and nurses were trained in MI. During yearly well-child checks, MI was conducted either by a nurse or physician to develop patient-centered goals. To reinforce adherence to set yearly goals; the clinic manager sent monthly progress reports to providers. Our measures of improvement were 1. Percentage of patients with a well-child check within the past year. 2. BMI listed on the problem list. 3. Patient-centered goals in the EHR. The analysis included McNemar's Chi-square tests for proportions to compare baseline (Nov 2016) and one-year follow-up (Nov 2017). Results: The study clinic has six providers with the panel size of approximately 5700 patients of which 11% are obese. Please see the attached table Conclusion: In this primary care clinic, the EHR was successfully used to create an online registry to increase attention to obesity management using a team-based approach. We improved well-child check rates and patient-centered goal setting for this at-risk population. This approach can potentially be helpful in early identification and intervention of obesity co-morbidities. This study demonstrates the use of EHR to capture point-of-care data to inform and improve obesity management in primary care through quality improvement projects. There is potential to develop additional online registries to