ObjectiveTo evaluate the validity of multi-institutional electronic health record (EHR) data sharing for surveillance and study of childhood obesity.MethodsWe conducted a non-concurrent cohort study of 528,340 children with outpatient visits to six pediatric academic medical centers during 2007–08, with sufficient data in the EHR for body mass index (BMI) assessment. EHR data were compared with data from the 2007–08 National Health and Nutrition Examination Survey (NHANES).ResultsAmong children 2–17 years, BMI was evaluable for 1,398,655 visits (56%). The EHR dataset contained over 6,000 BMI measurements per month of age up to 16 years, yielding precise estimates of BMI. In the EHR dataset, 18% of children were obese versus 18% in NHANES, while 35% were obese or overweight versus 34% in NHANES. BMI for an individual was highly reliable over time (intraclass correlation coefficient 0.90 for obese children and 0.97 for all children). Only 14% of visits with measured obesity (BMI ≥95%) had a diagnosis of obesity recorded, and only 20% of children with measured obesity had the diagnosis documented during the study period. Obese children had higher primary care (4.8 versus 4.0 visits, p<0.001) and specialty care (3.7 versus 2.7 visits, p<0.001) utilization than non-obese counterparts, and higher prevalence of diverse co-morbidities. The cohort size in the EHR dataset permitted detection of associations with rare diagnoses. Data sharing did not require investment of extensive institutional resources, yet yielded high data quality.ConclusionsMulti-institutional EHR data sharing is a promising, feasible, and valid approach for population health surveillance. It provides a valuable complement to more resource-intensive national surveys, particularly for iterative surveillance and quality improvement. Low rates of obesity diagnosis present a significant obstacle to surveillance and quality improvement for care of children with obesity.

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Background and Objective Clinical pathways standardize care for common health conditions. We sought to assess whether institution-wide implementation of multiple standardized pathways was associated with changes in utilization and physical functioning after discharge among pediatric inpatients. Methods Interrupted time series analysis of admissions to a tertiary care children’s hospital from 12/1/09–3/30/14. Based on diagnosis codes, included admissions were eligible for one of 15 clinical pathways implemented during the study period; admissions from both before and after implementation were included. Post-discharge physical functioning improvement was assessed with the PedsQL™ 4.0 generic core or infant scales. Average hospitalization costs, length of stay (LOS), readmissions, and physical functioning improvement scores were calculated by month relative to pathway implementation. Segmented linear regression was used to evaluate differences in intercept and trend over time before and after pathway implementation. Results There were 3808 and 2902 admissions in the pre-pathway and post-pathway groups, respectively. Compared to pre-pathway care, post-pathway care was associated with a significant halt in rising costs (pre-pathway vs. post-pathway slope difference −$155/month [95% CI −$246, −$64]; P=.001) and significantly decreased LOS (pre-pathway vs. post-pathway slope difference −0.03 days per month [95% CI −0.05, −0.02]; P= .02), without negatively impacting patient physical functioning improvement or readmissions. Conclusions Implementation of multiple evidence-based, standardized clinical pathways was associated with decreased resource utilization without negatively impacting patient physical functioning improvement. This approach could be widely implemented to improve the value of care provided.

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