The effect of an automated point of care tool on diagnosis and management of childhood obesity in primary care.
BACKGROUND
Childhood obesity is underdiagnosed in primary care practices. Our study aimed to compare rates of documentation of diagnosis of obesity and counselling for nutrition and physical activity at an academic primary care practice prior to and following implementation of a body mass index (BMI)-based electronic point of care clinical reminder tool.


METHODS
We performed a retrospective record review of children aged 2-18 years undergoing well child visits during any of three calendar years (2009, 2011 and 2013). The electronic clinical reminder tool was implemented in September 2010. Records of children with BMI > 95th percentile were electronically searched for terms of documentation of diagnosis of obesity and nutrition and physical activity counselling. Multivariable logistic regression models were used to adjust for potential patient and provider confounders.


RESULTS
Among those with BMI ≥ 95th percentile, there was a statistically significant increase in documentation of diagnosis of obesity (45.5% in 2009 vs. 52.4% in 2011; P < 0.001; adjusted odds ratio 1.36; 95% CI 1.13-1.65) and in counselling for physical activity and nutrition (66.8% in 2009 vs. 75.2% in 2011; P < 0.001; adjusted odds ratio 1.33; 95% CI 1.06-1.66) following implementation of the tool. Compared with 2011, there was no statistically significant increase in documentation of obesity (50.4%) or nutrition and physical activity counselling (77.9%) in 2013.


CONCLUSIONS
The implementation of a point of care clinical reminder tool was associated with improvement in documentation of diagnosis of obesity and counselling for nutrition and physical activity. Further studies are needed to determine the impact of these automated tools on weight outcomes in children.
Department of Family Medicine, Mayo Clinic, Rochester, MN, USA.
Natalie
N
Gentile
Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.
Valeria
V
Cristiani
Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.
Brian A
BA
Lynch
Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
Patrick M
PM
Wilson
Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
Amy L
AL
Weaver
Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
Lila J
LJ
Rutten
Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
Debra J
DJ
Jacobson
Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Rajeev
R
Chaudhry
Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, USA.
Swetha
S
Sriram
Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, USA.
Seema
S
Kumar
D000293:Adolescent; D001331:Automation; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008485:Medical Audit; D063766:Pediatric Obesity / Q000175:diagnosis* / Q000178:diet therapy*; D019095:Point-of-Care Systems; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D012189:Retrospective Studies; D012984:Software
diagnosis; health care; health services research