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Evaluating the implementation of expert committee recommendations for obesity assessment
Mona Sharifi1, Sheryl L Rifas-Shiman, Richard Marshall
1Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA 02115, USA. mona.sharifi@childrens.harvard.edu
Insights
Despite guidelines, most children with overweight/obesity lack diagnosis codes and recommended lab tests. This highlights a gap in clinical practice for pediatric obesity management.
Area of Science:
- Pediatrics
- Public Health
- Clinical Medicine
Background:
- Childhood overweight and obesity rates are rising, along with associated health problems.
- Clinical diagnosis and screening for these conditions remain low.
- Expert Committee recommendations were issued in 2007 to guide pediatric overweight/obesity management.
Purpose of the Study:
- To assess the uptake of clinical guidelines for pediatric overweight/obesity management.
- To evaluate the assignment of diagnosis codes and ordering of laboratory tests for children with overweight/obesity.
- To identify gaps in care following the release of expert recommendations.
Main Methods:
- A retrospective analysis of electronic health record data from a Massachusetts multisite group practice.
- Random selection of one well-child visit per child in 2006 and 2008.
- Identification of children aged 2-17 years with incident overweight or obesity (BMI ≥ 85th percentile).
- Ascertainment of relevant ICD-9 diagnosis codes and recommended laboratory tests for children aged 10+.
Main Results:
- A significant majority of children with overweight/obesity (BMI ≥ 85th percentile) lacked appropriate diagnosis codes.
- Recommended laboratory tests for assessing obesity-related comorbidities were not ordered for most eligible children (≥10 years old).
- These trends were observed in the year following the 2007 release of expert recommendations.
Conclusions:
- Current approaches are insufficient to ensure guideline uptake in pediatric overweight/obesity care.
- There is a critical need to improve clinical adherence to established guidelines for managing pediatric obesity.
- Augmenting current strategies is necessary to enhance the diagnosis and management of childhood obesity and its complications.
Abstract:
The increasing prevalence of childhood overweight/obesity and their associated morbidities are well established, yet rates of diagnosis and screening for related conditions by clinicians are low. Expert Committee recommendations were released in 2007 to facilitate management of pediatric overweight/obesity. From well-child visits to a Massachusetts multisite group practice, we randomly selected 1 visit per child in 2006 (n = 56 374) and in 2008 (n = 69 681) and used electronic health record data to identify children with incident overweight or obesity (BMI ≥ 85th percentile) and ascertained whether clinicians assigned relevant ICD-9 (International Classification of Diseases, Ninth Revision) codes and ordered laboratory tests recommended for children ≥10 years old. In the year following the release of recommendations, a large majority of children 2 to 17 years old with a BMI ≥85th percentile lack diagnosis codes for overweight/obesity and recommended laboratory orders for assessment of obesity-related comorbidities for children 10 years and older, suggesting the need to augment current approaches to increase uptake of guidelines.
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