Impact of Electronic Health Record Clinical Decision Support on the Management of Pediatric Obesity

Abstract

Clinicians vary significantly in their adherence to clinical guidelines for overweight/obesity. This study assessed the impact of electronic health record-based clinical decision support in improving the diagnosis and management of pediatric obesity. The study team programmed a point-of-care alert linked to a checklist and standardized documentation templates to appear during health maintenance visits for overweight/obese children in an outpatient teaching clinic and compared outcomes through medical record reviews of 574 (287 control and 287 intervention) visits. The results demonstrated a statistically significant increase in the diagnosis of overweight/obesity, scheduling of followup appointments, frequency of ordering recommended laboratory investigations, and assessment and counseling for nutrition and physical activity. Although clinical guideline adherence increased significantly, it was far from universal. It is unknown if modest improvements in adherence to clinical guidelines translate to improvements in children's health. However, this intervention was relatively easy to implement and produced measurable improvements in health care delivery.

Primary care interventions to reduce childhood obesity and sugar‐sweetened beverage consumption: Food for thought for oral health professionals

“…Our review contained 11 articles demonstrating that electronic health systems and office‐based practice tools improve care and communication for PCPs addressing childhood obesity (Table ) . Shaikh et al documented that adoption of electronic provider prompts and reminders in a teaching clinic resulted in a significant increase in diagnosis and follow‐up for overweight and obese pediatric patients . In a point‐of‐care study of clinical decision support by Taveras et al, obese children seen in a clinic using more advanced EHR capabilities had less increase in their BMI than those in usual care .…”

The effect of an automated point of care tool on diagnosis and management of childhood obesity in primary care

“…Our findings of an improvement in documentation of diagnosis of obesity following implementation of a point of care clinical tool are consistent with those by two other groups . Ayash and colleagues noted an increase in the rate of diagnosis of obesity in a multisite practice following implementation of a computerized alert for BMI > 95th percentile .…”

“…ICD‐9 coding alone has not been found to be effective in identifying obesity prevalence rates . Another difference relates to the racial/ethnic and socio‐economic status of the study population with majority of our patients being Caucasian and having private insurance while the other two studies had greater racial/ethnic heterogeneity and higher proportion of children covered by public insurance .…”

“…Our findings of increase in rates of counselling following implementation of the clinical alert are similar to those reported previously among overweight and obese children by Shaikh et al . following implementation of an alert for BMI > 85th percentile and an electronic checklist for obesity diagnosis and related co‐morbidities. Use of an electronic health record template with several obesity‐related elements including dietary habits such as juice intake, fruit and vegetable intake, screen time and physical activity habits also was noted to result in improvement in counselling for nutrition and physical activity in severely obese children under the age of 6 years .…”

“…Best practice alerts for body mass index (BMI) above the healthy weight range have been integrated in electronic health records in various practices. However, there is limited data on the impact of these alerts on diagnosis and counselling for obesity [10][11][12][13].…”