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Reminder Cards Improve Physician Documentation of Obesity But Not Obesity Counseling
Nicholas Shungu1, Marshal N Miller, Geoffrey Mills
1Department of Family Medicine, University of North Carolina.
Insights
Physical reminder cards improved obesity documentation by physicians. However, they did not significantly increase the documentation of obesity-related counseling, suggesting under-documentation persists.
Area of Science:
- Medical Informatics
- Clinical Practice Improvement
- Public Health
Background:
- Physician documentation of obesity and related counseling is often inadequate.
- Electronic Medical Record (EMR) systems present challenges for comprehensive data capture.
Purpose of the Study:
- To evaluate the effectiveness of physical reminder cards in enhancing obesity assessment and counseling documentation within EMRs.
- To compare EMR documentation rates with physician self-reported rates.
Main Methods:
- A 2-week intervention using reminder cards attached to patient encounter forms.
- Retrospective review of EMR data for obesity assessment and dietary counseling documentation before and during the intervention.
- Comparison of EMR data with physician self-reported documentation.
Main Results:
- Significant improvement in the assessment of obesity or morbid obesity as an active problem (42.5% vs. 28%).
- No significant difference in free-text dietary counseling or assessment of dietary counseling as an active problem.
- Physician self-reported documentation rates for obesity and counseling were substantially higher than EMR-documented rates.
Conclusions:
- Physical reminder cards effectively increase obesity documentation rates among healthcare providers.
- These interventions do not necessarily improve the documentation of obesity-related counseling.
- Physicians likely under-document both obesity and counseling, even with reminder systems.
Background And Objectives:
Physicians frequently fail to document obesity and obesity-related counseling. We sought to determine whether attaching a physical reminder card to patient encounter forms would increase electronic medical record (EMR) assessment of and documentation of obesity and dietary counseling.
Methods:
Reminder cards for obesity documentation were attached to encounter forms for patient encounters over a 2-week intervention period. For visits in the intervention period, the EMR was retrospectively reviewed for BMI, assessment of "obesity" or "morbid obesity" as an active problem, free-text dietary counseling within physician notes, and assessment of "dietary counseling" as an active problem. These data were compared to those collected through a retrospective chart review during a 2-week pre-intervention period. We also compared physician self-report of documentation via reminder cards with EMR documentation.
Results:
We found significant improvement in the primary endpoint of assessment of "obesity" or "morbid obesity" as an active problem (42.5% versus 28%) compared to the pre-intervention period. There was no significant difference in the primary endpoints of free-text dietary counseling or assessment of "dietary counseling" as an active problem between the groups. Physician self-reporting of assessment of "obesity" or "morbid obesity" as an active problem (77.7% versus 42.5%), free-text dietary counseling on obesity (69.1% versus 35.4%) and assessment of "dietary counseling" as an active problem (54.3% versus 25.2%) were all significantly higher than those reflected in EMR documentation.
Conclusions:
This study demonstrates that physical reminder cards are a successful means of increasing obesity documentation rates among providers but do not necessarily increase rates of obesity-related counseling or documentation of counseling. Our study suggests that even with such interventions, physicians are likely under-documenting obesity and counseling compared to self-reported rates.
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