P2B280: Measures That Matter: A Community Engaged Approach to Weight Management Quality Measures

Purpose/Objectives: The prevalence of unhealthy weight among children has increased significantly over decades including in patients served by Community Health Centers (CHCs). Families receiving primary care at CHCs face systemic and structural inequities that introduce barriers to achieving or maintaining healthy weight. CHCs play a critical role in addressing disparities through education, prevention, and management of obesity and comorbidities. There is consensus among clinicians at CHCs that the current clinical quality measure (CQM) on weight assessment and counseling for nutrition and physical activity does not capture efforts to address obesity, improve practice, or translate into effective knowledge of impacts of obesity. The objective of this project was to use a mixed-methods, stakeholder driven approach to 1) understand the prevalence of obesity in populations served by CHCs 2) inform potential new CQMs to better assess and promote healthy weight in childhood and 3) test the implementation of potential new CQMs in real-world settings.

Design/Methods: In partnership with the Center for Disease Control and Prevention (CDC) and National Association of Community Health Centers (NACHC), AllianceChicago, a national network of over 70 CHCs, engaged CHCs across in the U.S. in exploring enhancements to pediatric weight management CQMs. After comprehensive literature review, feedback on new potential CQMs associated with weight management was gathered from CHC pediatricians through surveys and qualitative data collection regarding clinical significance, feasibility, usefulness in practice, and data capture in a clinical workflow. This list was then refined and used to examine the feasibility of calculating CQMs by examining patient data from Electronic Health Records from 2019 and 2021. A refined list of CQM aligning with the 2023 Clinical Practice Guidelines was then developed and tested in real world settings.

Results: Data analysis from a national cohort of CHCs serving populations experiencing disparities revealed a high prevalence of obesity and overweight status exceeding national rates. The prevalence of obesity increased from 2019 to 2021 with the highest increase in children 6-11 years of age. Data revealed opportunities to improve guideline-concordant practice in screening for obesity related comorbid conditions, screening for food insecurity, and follow up that supports behavior change. A measure testing pilot was launched to test 2 potential weight management CQMs demonstrated feasibility and a high level of acceptance for implementation in community health.

Conclusion/Discussion: Engaging stakeholders in all phases of measure design and development is essential to ensure clinical relevance and feasibility of quality measures. The results from our initiative demonstrate that the prevalence of obesity in resource limited settings is higher than national prevalence with a marked increase in unhealthy weight status pre- and post-pandemic. This project underscores the need for quality measures and patient-centered interventions that are feasible in primary care as well as advocacy for resources in underserved communities.