Back-Ground

1. A QI intervention in a resident primary care clinic to improve recognition and treatment of overweight and obese children Carly Scahill DO, Talia Glasberg MD, Molly Beleckis MD, Justin Ruoss MD, Kristina Gustafson MD MSCR, Annie Andrews MD MSCR

2. Back-Ground • 1 in 3 children in the US are overweight or obese (CDC 2010) • 80% of children who were overweight at age 10-15 were obese by age 25 (CDC 2010)

3. PLAN • Assessing the current situation • Trying to determine why there is a problem • Coming up with a solution for improvement

4. Plan – Assess Current Situation • Assess our current situation and need for improvement • Determining if overweight/obesity is a problem • Prevalence of Overweight/Obese = 32.5%

5. PLAN – Assess current situation • Determine if we need improvement with diagnosing and treating this population • 2007 AAP- consensus statement regarding guidelines for diagnosing and treating overweight and obese children • Diagnosing BMI Percentile • Overweight BMI 85th%- 94th% • Obese  BMI > 95th% • Treatment and Prevention • In office counseling • 5-2-1-0 Rule • Every 2 year screening labs on patient >10yo • Lipids, AST, ALT, Blood glucose • Follow up every week to 3 months • Referral when necessary

6. PLAN – ASSESS CURRENT SITUATION • Retrospective chart review – well child checks 2010 • (N=100 overweight, N=100 obese) • Obesity/Overweight • Diagnosing 35% / 0% • Counseling 42% / 4% • F/U < 1 year 53% / 35% • Lipids 38% / 8% • AST/ALT 38% / 5% • Blood glucose 25% / 3% • Referrals 12% / 2%

7. PLAN – DETERMINING WHY THERE IS A PROBLEM • Lack of understanding the AAP recommendations • Difficulty determining BMI% with current system • Simply forgetting

8. Plan – coming up with solution • Objective • To improve identification and treatment of our overweight and obese patients • 1st – solution • Automatically calculate BMI % • Reminder in WCC template • Low tech, low cost intervention, easily adaptable

9. DO - Intervention • Educating physicians • Placing reminders at physician work stations • BMI cutoff value postings

10. DO- Intervention • AAP Treatment Guideline postings

11. DO - Intervention • Easily accessible weight counseling resources

12. DO - Intervention

13. Study and Act • Monthly retrospective chart reviews - Outcome variables • Documentation/Diagnosing obesity/overweight • Weight loss counseling • Referrals • Screening labs recommended by AAP • Follow up appointment <1 year

14. Results – Progress For Obese Patients

15. Results – Progress for overweight patients

16. Conclusion • Through implementation of a low tech, low cost obesity intervention we have seen substantial improvement in recognizing our overweight and obese patients and improved rates of weight counseling, appropriate screening labs ordered, and more frequent follow-up

17. Future Direction • Place more of a focus on improving the diagnosis and treatment of our overweight population • Determine if our improved diagnosis and treatment is actually decreasing the prevalence of overweight and obesity in our clinic • Take our intervention to the next step with changes in EMR