title: Evaluation of an electronic health record-supported obesity management protocol implemented in a community health center: a cautionary note.
abstract: Primary care clinicians are well-positioned to intervene in the obesity epidemic. We studied whether implementation of an obesity intake protocol and electronic health record (EHR) form to guide behavior modification would facilitate identification and management of adult obesity in a Federally Qualified Health Center serving low-income, Hispanic patients.
  
  
  
  In three studies, we examined clinician and patient outcomes before and after the addition of the weight management protocol and form. In the Clinician Study, 12 clinicians self-reported obesity management practices. In the Population Study, BMI and order data from 5000 patients and all 40 clinicians in the practice were extracted from the EHR preintervention and postintervention. In the Exposure Study, EHR-documented outcomes for a sub-sample of 46 patients actually exposed to the obesity management form were compared to matched controls.
  
  
  
  Clinicians reported that the intake protocol and form increased their performance of obesity-related assessments and their confidence in managing obesity. However, no improvement in obesity management practices or patient weight-loss was evident in EHR records for the overall clinic population. Further analysis revealed that only 55 patients were exposed to the form. Exposed patients were twice as likely to receive weight-loss counseling following the intervention, as compared to before, and more likely than matched controls. However, their obesity outcomes did not differ.
  
  
  
  Results suggest that an obesity intake protocol and EHR-based weight management form may facilitate clinician weight-loss counseling among those exposed to the form. Significant implementation barriers can limit exposure, however, and need to be addressed.
authors: Department of Preventive Medicine, Northwestern University, 680 N Lake Shore Dr, Chicago, IL 60611, USA jeremy.steglitz@northwestern.edu.
authors: Jeremy
authors: J
authors: Steglitz
authors: Deborah
authors: D
authors: Edberg
authors: Erie Family Health Center, Chicago, IL, USA.
authors: Mary
authors: M
authors: Sommers
authors: Erie Family Health Center, Chicago, IL, USA.
authors: Mary R
authors: MR
authors: Talen
authors: Department of Preventive Medicine, Northwestern University, 680 N Lake Shore Dr, Chicago, IL 60611, USA Priority Research Centre for Translational Neuroscience and Mental Health, University of Newcastle, Australia.
authors: Louise K
authors: LK
authors: Thornton
authors: Department of Preventive Medicine, Northwestern University, 680 N Lake Shore Dr, Chicago, IL 60611, USA.
authors: Bonnie
authors: B
authors: Spring
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D015992:Body Mass Index; D002983:Clinical Competence; D003151:Community Health Centers; D003376:Counseling / Q000706:statistics & numerical data*; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D009722:Nurse Practitioners; D009765:Obesity / Q000628:therapy*; D010820:Physicians; D011320:Primary Health Care; D015431:Weight Loss
keywords: community health; electronic health record; evidence-based practice; obesity; primary care