P2B307: Making the Diagnosis: Utilization of Quality Improvement Methodology to Improve Diagnosis of Obesity and Diet Related Chronic Disease in an Urban Academic Community Health Center

Purpose/Objectives: Obesity is a chronic multifactorial disease affecting 20% of children and adolescents.1 National guidelines recommend diagnosis of obesity starting at age 2, with BMI >95th%, as well as screening for specific comorbidities based on risk factors.2 However, proper use of diagnosis codes are not always utilized appropriately and many clinicians lack the knowledge of the recommended labs to order. Our objective was to conduct a quality improvement(QI) initiative to drive practice change in the diagnosis of obesity and its comorbidities through appropriate clinical screening, documentation, and coding.

Design/Methods: Two academic primary care clinics in Washington, DC completed a 12-month QI initiative after a clinician needs survey demonstrated the potential for more institutional support to address barriers identified at addressing the diagnosis of obesity & diet-related chronic diseases. A 12-month baseline(02/2020 - 02/2021) of the current clinic documentation practices was identified by reviewing charts of patients between 2-18 years of age and with a BMI >95th%. 4 variables were tracked including: documentation of BMI percentiles utilizing Z-codes; documentation of diagnosis codes associated with weight status utilizing E-codes; ordering of appropriate screening labs based on current guidelines; and documentation of diagnoses associated with abnormal lab results. The QI initiative(03/2021- 03/2022) incorporated integration of evidenced based clinical algorithms, monthly educational training and coaching sessions on appropriate ways to document diagnoses and order labs. PDSAs were implemented during the intervention period. Chart reviews were performed throughout the QI initiative and 6 months afterwards to observe how documentation of diagnostic criteria changed during and after interventions.

Results: Baseline data showed significant clinician differences in screening. During the intervention, an observable downward trend in extraneous labs was noted in both clinics, with an increase in extraneous labs during post intervention period(Fig 1). After multiple training sessions, the use of both E & Z obesity codes significantly increased at both clinics, going from a baseline of < 20% and sustained >75% of charts through the post intervention period(Fig 2).

Conclusion/Discussion: Data from both clinics suggest that through a QI program consisting of training and education, pediatricians can improve their clinical decision making when it comes to diagnosing, billing and documenting obesity & diet-related chronic diseases. While lab collection was more standardized during the intervention this was not as consistently maintained as the coding and billing. More structured EHR reminders may be a more sustainable way to change provider behavior in lab collection.