P2B274: Including a Focus on Weighing & Measuring Accuracy Standards Within a Quality Improvement Project to Support Early Obesity Prevention

Purpose/Objectives: The Optimize Infant and Toddler Feeding for Obesity Prevention (“Optimize Feeding”) project was developed based on studies, showing gaps in the care provided by Primary Care Providers (PCPs) to support healthy lifestyles and growth during well visits with children < 2 years. Optimize Feeding is a 19-week, team-based, virtual quality improvement (QI) collaborative that has shown substantial clinical improvements during 2 project rounds. Nevertheless, an additional gap concerning accurate weighing and measuring procedures was uncovered, warranting additional intervention. The objective of this analysis was to examine results of clinical improvements and PCP satisfaction levels during Round 3 (R3), during which a new checklist was developed, to support accurate growth assessments.

Design/Methods: Participating teams during each round (n=16, 11, and 10, respectively) were provided with a Key Driver diagram, trainings, tools, and other resources (e.g., webinars, technical assistance) to facilitate a tailored, comprehensive approach to care during well visits with children < 2 years. Improvement foci/clinical measures included assessments of pre-perinatal risk factors, weight- for-length percentile and assessments and counseling regarding diet/nutrition, the parenting/home lifestyle environment, and social determinants of health. Teams submitted data (20 randomly selected charts) at 3 time points (T1-3) during the collaborative (weeks 9, 16, and 16) and again during a “monitoring data cycle,” 6 months later. During R3, at the beginning and end of the collaborative, teams completed a weighing and measuring checklist (equipment, procedures, trainings), to focus attention on accurate weighing and measuring (Table 1). Within post-project surveys, PCPs answer a 7-point bipolar question concerning satisfaction with participation (response rates: R1=65%; R2=76%; R3=72%). Leads were also asked to report whether their team had changed weighing and measuring procedures. Changes in aggregate clinical measures were analyzed using Fisher’s exact test (p <.025); surveys were analyzed descriptively.

Results: During R1 & R2, by T3 most clinical measures had improved (R1=8; R2=6), and at T4, improvements were generally sustained or increased (R1=7; R2=9) (Table 2). Significant improvements were also observed during R3, although there were fewer (T3=3; T4=4), suggesting that adding the weighing and measuring checklist may have reduced attention to some other types of improvements. Nevertheless, during R3, half of Leads reported improvements to procedures related to accurate weighing and measuring, compared with < 10% during R1-2. Also, the percentage of PCPs reporting moderate to extremely high levels of overall satisfaction was similar or higher (R1=75%, R2=78%, R3=93%). Based on R3 results, the weighing and measuring checklist and a formal improvement focus on accurate weighing and measuring were integrated into future rounds.

Conclusion/Discussion: Substantial clinical improvements and high satisfaction levels were observed during all project rounds. QI projects focused on early obesity prevention/healthy growth should be aware of the possibility of inaccuracies in weighing and measuring and consider including appropriate interventions.