title: 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 follow-up 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.
authors.affiliation: University of California Davis School of Medicine, Sacramento, CA ushaikh@ucdavis.edu.
authors.forename: Ulfat
authors.initials: U
authors.lastname: Shaikh
authors.affiliation: University of California Davis School of Medicine, Sacramento, CA.
authors.forename: Jeanette
authors.initials: J
authors.lastname: Berrong
authors.affiliation: University of California Davis School of Medicine, Sacramento, CA.
authors.forename: Jasmine
authors.initials: J
authors.lastname: Nettiksimmons
authors.affiliation: University of California Davis School of Medicine, Sacramento, CA.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Byrd
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D057189:Checklist; D002648:Child; D002675:Child, Preschool; D003376:Counseling; D020000:Decision Support Systems, Clinical / Q000458:organization & administration* / Q000592:standards; D004032:Diet; D057286:Electronic Health Records / Q000458:organization & administration* / Q000592:standards; D015444:Exercise; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D050177:Overweight / Q000175:diagnosis / Q000628:therapy; D063766:Pediatric Obesity / Q000175:diagnosis* / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D011787:Quality of Health Care / Q000458:organization & administration; D012307:Risk Factors
keywords: adolescent; child; decision-support system; medical informatics; obesity; quality of care