title: Reminder Cards Improve Physician Documentation of Obesity But Not Obesity Counseling.
abstract: OBJECTIVE
  Physicians frequently fail to document obesity and obesity-related counseling. We sought to determine whether attaching a physical reminder card to patient encounter forms would increase electronic medical record (EMR) assessment of and documentation of obesity and dietary counseling.
  
  
  METHODS
  Reminder cards for obesity documentation were attached to encounter forms for patient encounters over a 2-week intervention period. For visits in the intervention period, the EMR was retrospectively reviewed for BMI, assessment of "obesity" or "morbid obesity" as an active problem, free-text dietary counseling within physician notes, and assessment of "dietary counseling" as an active problem. These data were compared to those collected through a retrospective chart review during a 2-week pre-intervention period. We also compared physician self-report of documentation via reminder cards with EMR documentation.
  
  
  RESULTS
  We found significant improvement in the primary endpoint of assessment of "obesity" or "morbid obesity" as an active problem (42.5% versus 28%) compared to the pre-intervention period. There was no significant difference in the primary endpoints of free-text dietary counseling or assessment of "dietary counseling" as an active problem between the groups. Physician self-reporting of assessment of "obesity" or "morbid obesity" as an active problem (77.7% versus 42.5%), free-text dietary counseling on obesity (69.1% versus 35.4%) and assessment of "dietary counseling" as an active problem (54.3% versus 25.2%) were all significantly higher than those reflected in EMR documentation.
  
  
  CONCLUSIONS
  This study demonstrates that physical reminder cards are a successful means of increasing obesity documentation rates among providers but do not necessarily increase rates of obesity-related counseling or documentation of counseling. Our study suggests that even with such interventions, physicians are likely under-documenting obesity and counseling compared to self-reported rates.
authors.affiliation: Department of Family Medicine, University of North Carolina.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Shungu
authors.forename: Marshal N
authors.initials: MN
authors.lastname: Miller
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Mills
authors.forename: Neesha
authors.initials: N
authors.lastname: Patel
authors.forename: Amanda
authors.initials: A
authors.lastname: de la Paz
authors.forename: Victoria
authors.initials: V
authors.lastname: Rose
authors.forename: Jill
authors.initials: J
authors.lastname: Kropa
authors.forename: Rina
authors.initials: R
authors.lastname: Edi
authors.forename: Emily
authors.initials: E
authors.lastname: Levy
authors.forename: Margaret
authors.initials: M
authors.lastname: Crenshaw
authors.forename: Chris
authors.initials: C
authors.lastname: Hwang
mesh_terms: D015992:Body Mass Index; D003376:Counseling / Q000706:statistics & numerical data*; D004282:Documentation / Q000706:statistics & numerical data*; D057286:Electronic Health Records; D006801:Humans; D009765:Obesity / Q000628:therapy*; D050177:Overweight / Q000628:therapy; D010821:Physicians, Family / Q000706:statistics & numerical data*; D017010:Reminder Systems / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014505:Urban Population