1. Summary and Conclusion:
Pediatric Obesity – A Practice Improvement Project
Kim Hageman, MD and Robert Luebbers, MD
University of Vermont College of Medicine, Burlington, VT
Before: After collage.
Traditional classroom activity contrasted with Standardized Patient experience.
Doctor/patient 1:1 contrasted with team exercise.
Picture from hands-on workshop (suturing, casting, etc.)
The fair (off the web)
Doctor talking down to patient:doctor sitting down with patient, looking at computer
Student teaching at a school (health at gym)
Goal: Improve Management of Pediatric Obesity in Family Medicine Practices.
Background:
Obesity represents a significant public health problem. It is a clinical risk factor for heart disease, hypertension, diabetes, hyperlipidemia, and other health conditions.
The prevalence of childhood overweight and obesity is high and has increased overall since 1999 (1)
Current guidelines recommend identification of overweight and obese children and adolescents according to BMI percentile, screening laboratory testing for those at risk for complications, as well as referral and follow up for management of obesity (2,3)
Results:
Objectives:
Determine the prevalence of overweight and obese pediatric patients in Family Medicine clinics.
Improve identification of overweight and obese pediatric patients in our clinics
Increase assessment and counseling of nutrition and physical activity, goal setting and follow plans.
Summary and Conclusion:
Approximately 30% of children were overweight or obese. This was similar across all practice sites.
Proportion of overweight and obese children increased with age until adolescence.
MOC project participation resulted in overall improvement in documentation of weight status, nutrition and physical activity assessment and counseling.
Documentation of goal setting and follow up plans also improved.
It is unclear whether participation in MOC project resulted in increased laboratory monitoring or decrease in proportion of overweight and obese children and adolescents in our practices. *
Methods:
Each of our 5 outpatient Family Medicine sites participated in a practice improvement process sponsored by Vermont Child Health Improvement Program (VCHIP) Child Health Advances Measured in Practice (CHAMP) Maintenance of Certification (MOC) project.
EHR data was obtained for baseline measurements of BMI for all children ages 2-21 years in the practices.
Monthly chart reviews of patients seen for health maintenance visits were performed from October, 2014 to April, Documentation was assessed for weight status, nutrition and physical activity assessment and counseling,
References
1. Sogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of Childhood and Adult Obesity in the United States, JAMA. 2014;311(8): doi: /jama
Med Decis Making Jan;35(1): doi: / X Epub 2014 Oct 28.
2. Expert Committee Recommendations on the Assessment, Prevention and Treatment of Child and Adolescent Overweight and Obesity – An implementation Guide from the Childhood Obesity Action Network.
3. Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Summary Report. Pediatrics Volume 128, Supplement 6, December 2011.