Quality Improvement Project- Documenting BMI Quality Improvement (QI)- An excellent method of analyzing a particular clinical practice, implementing change in that practice and assessing the effects of changes. The overall goal is to measure where you are and devise strategies to make you better. Measurement of BMI can be improved through the use of Quality Improvement Projects. The importance of QI initiatives is being increasingly recognized in the medical world. Quality Improvement is a formal approach (both prospective and retrospective) to the review & analysis of performance and systematic efforts to improve it. It is aimed at improvement -- measuring where you are, and figuring out ways to make things better. It specifically attempts to avoid attributing blame, and to create systems to prevent errors from happening.

Quality Improvement Project- Improving the Documentation of BMI QI Projects focused on improving the measurement of BMI can be on a target population (eg. Greater than 2 years) or on the entire population served by a particular institution. The ideas used in the following QI Project description have been adapted from “Teaching Immunization Delivery and Evaluation,” also known as TIDE, and can be found at the website: http://www2.edserv.musc.edu/tide/reg/main.las

Designing a QI Project- Improving the Documentation of BMI Step 1: Assess the measurement of BMI. Two possible methods are: Chart Method- uses data from randomly selected medical records. Consecutive Method- collects data of consecutive children as they are seen for care. Easiest method to implement!! Record data on a Standardized Encounter Record for each patient. The Chart Method is the most widely used method. One disadvantage is that this method may include patients who are no longer patients of the practice. The Consecutive Method works in the following manner: screen 30 consecutive patients for measurement of BMI during their visits (both acute visits and well-child care are included). For example, start at 10 AM on a particular day and screen every child until you have 30. While this method is the easiest, the disadvantage is that frequent clinic patients are oversampled, often leading to an over-estimation of immunization rates.

Designing a QI Project- Improving the Documentation of BMI Step 2: Improving BMI Measurement Describe and analyze key office routines related to measuring BMI. Based on findings in 1), select interventions likely to improve the measurement of BMI. Focus on the “Vital Few” interventions rather than the “Useful Many.” In analyzing key office routines, some examples of questions are: Is the weight recorded for each visit? Is the height recorded for each visit? Are these values used to calculate BMI? Is there a place on the chart to record the patient’s BMI. Is there a growth chart which includes BMI? 3) The Pareto Principle is used in QI efforts and allows one to identify the “Vital Few” interventions that would have the greatest impact on the measurement of BMI in the office setting. For example, if the practice uses written charts and there is no place to record the BMI, then that would be one of the vital few!! Likewise, if the practice uses electronic charts and the BMI is not part of a standardized chart, then that too would be one of the vital few! It is important to identify and choose the “Vital Few” interventions likely to have the greatest impact on immunization rates rather than focusing on the “Useful Many.”

Designing a QI Project- Improving the Documentation of BMI Step 3: Assessing the Effects of Changes Assess BMI Measurements again after a specified period of time. Key Points It is important that key players buy into project! Incentives are very important! Any good QI Project requires the participation of the key players: administrative staff, clerical staff, nurses and nurse aides, and providers. Therefore, incentives for participating in QI Project as well as awards for achieving excellent results are vital: some examples are free lunches/parties, extra time off, gift cards, certificates, etc.

Designing a QI Project The nuts and bolts of this sample QI project can be used to conduct a QI project to improve any clinical practice related to obesity advocacy. Some example clinical practices: counseling on exercise and diet, providing handouts or prescriptions for diet/exercise, ensuring follow-up for obese patients, going over 5-2-1-0. The list goes on…..