P2B306: Implementation of Childhood Obesity Identification and Intervention in a Pediatric Continuity Care Clinic: A Quality Improvement Project

Purpose/Objectives: Childhood obesity is a multifactorial condition affecting approximately 14.4 million children and adolescents in the United States. Body mass index (BMI) is frequently used as a screening and diagnostic tool for childhood obesity due to its accessibility and ease of use. A child with a BMI in the 95th percentile or greater for their sex and age is considered "obese," and a child with a BMI in the 99th percentile or greater is considered to have “severe obesity.” To address this growing public health concern, we implemented a quality improvement project in our primary care clinic aimed at improving diagnosis and documentation of patients with elevated BMI as well as ensuring patients have appropriate evaluation for comorbidities.

Design/Methods: Baseline data was collected from August-September 2022. Visits were selected based on a patient’s documented BMI at or above 99th percentile. Information was collected via retrospective chart review on labs and referrals placed for that encounter, visit diagnoses, and any documentation of obesity-related counseling. Three SMART aims were set: to increase the percentage of patients with a BMI ≥95th percentile with documented counseling on lifestyle and nutrition changes, to increase the percentage of patients with a BMI ≥99th percentile with labs (AST/ALT, HgbA1c, lipids) ordered and completed, and to increase the percentage of patients with a BMI ≥99th percentile with Pediatric Nutrition and/or Endocrine referral. Two separate educational sessions were provided to faculty members and pediatric residents to discuss pediatric obesity management, as well as the objectives and goals of our study. Additionally, a Community Health Worker (CHW) was assigned to the project and provided motivational interviewing via phone calls and scheduling assistance for lab/consultation visits.

Results: Additional data was gathered following the educational sessions and implementation of a CHW role for patient outreach to assess progress of SMART aims. Documentation of lifestyle and dietary change counseling during well visits increased from 61% (47/77) at baseline to 78% (14/18). The percentage of children with labs ordered to screen for comorbidities increased from 40% (31/77) to 67% (12/18). Children who had a consult with Pediatric Nutrition or Pediatric Endocrinology increased from 23% (18/77) to 55% (10/18). At baseline, only 36% of families had consultation visits scheduled. With this new intervention in place, our CHW reached out to families with labs/referrals ordered but not completed – 40% were able to be scheduled with their assistance.

Conclusion/Discussion: Following multiple educational sessions, the rate of labs and referrals ordered, as well as counseling provided during the patient encounter, was increased. Subsequently, the involvement of a CHW increased the rate of scheduling and follow up for our patients. While early data is promising, we hope to expand the interventions offered to providers and patients and continue to measure its sustainability.