O3028: A Quality Improvement Project to Support Implementation of the 2023 Obesity Clinical Practice Guideline During Pediatric Well Visits

Purpose/Objectives: In recent years, pediatric primary care providers (PCPs) have made considerable progress in providing recommended obesity care during well visits. However, some aspects of care, such as comprehensive comorbidity evaluations, remain challenging, and the new 2023 AAP pediatric obesity Clinical Practice Guideline (CPG) updated many standards of care. The Assessment and Evaluation of Pediatric Obesity quality improvement (QI) project is a new 25-week, virtual, team-based collaborative to improve evidence-based care for the prevention and prompt identification and evaluation of overweight/obesity in children ages 2 to 18 during well visits, consistent with CPG and Bright Futures recommendations. The objective of this abstract is to examine aggregate baseline measures for the project.

Design/Methods: To support the implementation of recommended care, participating teams are provided with a Key Driver Diagram (Figure) and various resources, including self-paced training modules, tools/resources for each Key Driver (e.g., growth charts; clinical flow sheets, checklists, etc.), and opportunities for peer support and technical assistance. During the collaborative, primary care teams attend national webinars, hold local meetings, engage in ongoing Plan-Do-Study-Act cycles, and submit 3 cycles of clinical data, plus a monitoring data cycle, held 4 months later. For each team and cycle, clinical measures are based on random samples of well visits for a) all children (10 charts; 4 measures) and b) children with overweight/obesity (15 charts; 12 measures). For children with overweight or obesity, measures pertain to care delivered during or within 4 weeks of well visits. Baseline clinical data were analyzed descriptively.

Results: The pilot was launched in March 2023, with 15 teams. For “all children” visits (n=152), observed values of clinical measures at baseline were higher for BMI documentation (88%) and prevention counseling (73%) than for assessing lifestyle behaviors (53%) or social determinants of health (28%). (Table) For visits with children with overweight or obesity(n=293), obesity class documentation (35%) and a comprehensive history/exam (10%) were uncommon. Hypertension evaluation was most consistent (88%), and comorbidity evaluations based on medical exams/tests (e.g., sleep apnea, depression) were typically done more routinely (54-65%) than those requiring labs (e.g., lipid abnormalities, prediabetes/diabetes; 24-39%). About half of visits with children with overweight or obesity (49%) resulted in some type of treatment plan, based on shared decision-making strategies.

Conclusion/Discussion: A few baseline measures for a QI project to improve obesity care during pediatric well visits approached 2023 standards of care, and nearly half of visits with children with overweight or obesity included some type of shared treatment plan. However, the vast majority of measures left much room for improvement, particularly those related to a comprehensive history/physical exam and recommended labs. Results of future data cycles will be used to assess the value of collaborative participation in improving evidence-based care.