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

Gentile, Natalie; Cristiani, Valeria; Lynch, Brian; Wilson, Philip; Weaver, Amy L.; Rutten, Lila J. Finney; Jacobson, Debra J.; Chaudhry, Rajeev; Sriram, Swetha; Kumar, Seema

doi:10.1111/jep.12572

Cited by 8 publications

(9 citation statements)

References 21 publications

(32 reference statements)

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“…28 Younger children, who were less likely to be given a weight diagnosis in our study, are more likely to achieve and sustain BMI reduction than adolescents, 13 which makes the recognition of overweight and obesity imperative in this population. BMI alert features in the medical record have also been demonstrated to improve documentation rates; however, the benefits of this intervention can be limited because of “provider alert fatigue.” 29 A bimodal approach that includes BMI alerts as well as templates mandating a BMI diagnosis may further improve and sustain weight diagnosis rates.…”

Section: Discussionmentioning

confidence: 99%

“…Modifications to the medical record, which alert providers to an elevated BMI with concomitant treatment options per pediatric obesity guidelines, have resulted in improved diagnosis and management. 29,32,33 Standardized templates within the electronic medical record with prompts in the assessment and treatment section of the chart related to pediatric obesity have also improved documentation and treatment. 34 Treatment algorithms within the electronic medical record and easy access to resources within the hospital and community would likely significantly improve pediatric obesity care; however, the challenge is to incorporate these interventions into the existing flow of well-child care.…”

Section: Discussionmentioning

confidence: 99%

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Characteristics of Correctly Identified Pediatric Obesity and Overweight Status and Management in an Academic General Pediatric Clinic

Morais

Kelly

Bost

et al. 2018

Clin Pediatr (Phila)

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This study identified and characterized the rates of documentation and guideline-based management of overweight and obese children within an academic pediatric clinic through a retrospective electronic medical record review of 7422 well-child visits in 2016. Diagnosis and treatment were analyzed by patient's weight diagnosis, sex, age, and provider training level. The percentages of correctly identified severely obese (90.2%), obese (77.0%), and overweight (42.0%) children were much higher than in previous retrospective chart reviews; however, less than 30% of children were referred for more intensive weight management to a dietitian or pediatric obesity weight management program. Increased provider training level was associated with a lower adherence to pediatric obesity guidelines. Strategic modifications to electronic medical records that automatically offer body mass index-associated weight diagnoses with a link to treatment pathways and resources are needed to facilitate improved compliance with current pediatric obesity guidelines in the primary care setting.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Characteristics of Correctly Identified Pediatric Obesity and Overweight Status and Management in an Academic General Pediatric Clinic

Morais

Kelly

Bost

et al. 2018

Clin Pediatr (Phila)

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“…However, change in BMI z ‐score among children with overweight favoured the non‐exposed group rather than the intervention group. Preventive counselling related to healthy eating and physical activity could have occurred in non‐intervention clinics to benefit the non‐exposed group but was unlikely . Alternatively, provider‐level factors such as years of practice or duration of the relationship with the family may offer insight for future research.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of enhancing well‐child visits with family nutrition and physical activity risk assessment on body mass index

Bailey‐Davis

Kling

Wood³

et al. 2019

Obesity Science & Practice

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Summary Objective Integration of behavioural risk assessment into well‐child visits is recommended by clinical guidelines, but its feasibility and impact is unknown. Methods A quasi‐experimental study evaluated the feasibility and effectiveness of risk assessment on body mass index (BMI) at 1‐year follow‐up. Children with assessments (intervention) were compared with those who did not complete assessments (non‐respondent) and those who received standard care (non‐exposed). Results Analyses included 10,647 children aged 2–9 years (2,724 intervention, 3,324 non‐respondent and 4,599 non‐exposed). Forty‐five per cent of parents completed the assessments. Intervention and non‐respondent groups differed in change in BMI z ‐score at 1 year by −0.05 (confidence interval [CI]: −0.08, −0.02; P = 0.0013); no difference was observed with non‐exposed children. The intervention group had a smaller increase in BMI z ‐score (0.07 ± 0.63) than non‐respondent group (0.13 ± 0.63). For children with normal weight at baseline, intervention versus non‐respondent groups differed in BMI z ‐score change by −0.06 (CI: −0.10, −0.02; P = 0.0025). However, children with overweight at baseline in the intervention versus the non‐exposed group differed in BMI z ‐score change (0.07 [CI: 0.02, 0.14]; P = 0.016). When analysed by age, results were similar for 2‐ to 5‐year‐olds, but no differences were found for 6‐ to 9‐year‐olds. Conclusion Automating risk assessment in paediatric care is feasible and effective in promoting healthy weight among preschool but not older children.

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“… 1 The diagnosis and management of several pathologies are also improved, which translates into better patient health, including as regards childhood and adult obesity. 2 , 3 , 4 , 5 , 6 , 7 , 8 …”

Section: Introductionmentioning

confidence: 99%

Childhood obesity diagnosis and management remains a challenge despite the use of electronic health records: A retrospective study

Paquette

Théorêt

Veilleux

et al. 2022

Health Science Reports

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Background The use of electronic health records (EHR) has revolutionized medical practice by improving the quality of care. Childhood obesity (CO) increases the risk of developing other chronic diseases and has a serious psychosocial impact on children. Using EHR may improve this clinical condition since early diagnosis is a crucial means of preventing its negative impacts. Objectives The aim of the study was to assess the diagnosis and management of CO in a Canadian academic family medicine group unit (FMG‐U) that uses EHR with an integrated CO diagnosis tool. Methods This is a retrospective study conducted in an FMG‐U in the province of Quebec. The clinical practice guidelines established by the World Health Organization (WHO) were used to assess diagnosis and management of CO. EHR of every patient from 5 to 12 years old who had a medical appointment at the FMG‐U in 2017 ( n = 618) were analyzed. EHR use by clinicians was assessed by a closed‐ended online survey sent to clinicians who provided pediatric care at that clinic in 2017. Results We identified 69 patients as obese according to the WHO, of whom 40 had been diagnosed by health professionals at the clinic. Of these, 33 received nutritional counseling; 33 received physical activity counseling; 13 received parent involvement counseling; 19 were referred to another health professional; and 12 were followed up within 6 months. Ten out of 15 clinicians responded to the survey. They all used the EHR integrated CO diagnosis tool but only 20% were truly familiar with it. Conclusions This study shows that CO is still underdiagnosed in primary care, notwithstanding the use of EHR with integrated tools. This affects the quality of care. Moreover, even if CO were correctly diagnosed, its management remains incomplete. Knowledge translation by medical organizations plays an important role in addressing this problem.

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

Cited by 8 publications

References 21 publications

Characteristics of Correctly Identified Pediatric Obesity and Overweight Status and Management in an Academic General Pediatric Clinic

Characteristics of Correctly Identified Pediatric Obesity and Overweight Status and Management in an Academic General Pediatric Clinic

Feasibility of enhancing well‐child visits with family nutrition and physical activity risk assessment on body mass index

Childhood obesity diagnosis and management remains a challenge despite the use of electronic health records: A retrospective study

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