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. B ACK -G ROUND 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. P LAN – A SSESS C URRENT S ITUATION Assess our current situation and need for improvement Determining if overweight/obesity is a problem Prevalence of Overweight/Obese = 32.5%

5. PLAN – A SSESS 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 85 th %- 94th% Obese BMI > 95 th % 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. P LAN – COMING UP WITH SOLUTION Objective To improve identification and treatment of our overweight and obese patients 1 st – solution Automatically calculate BMI % Reminder in WCC template Low tech, low cost intervention, easily adaptable

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

10. DO - I NTERVENTION AAP Treatment Guideline postings

11. DO - I NTERVENTION Easily accessible weight counseling resources

12. DO - I NTERVENTION

13. S TUDY AND A CT 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. R ESULTS – P ROGRESS F OR O BESE P ATIENTS

15. R ESULTS – P ROGRESS FOR OVERWEIGHT PATIENTS

16. C ONCLUSION 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. F UTURE D IRECTION 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