American College of Cardiology Body Mass Index Counseling Quality Improvement Initiative

Area of Science:

• Pediatric Cardiology
• Quality Improvement Science
• Public Health

Background:

• Overweight and obesity are significant cardiovascular risk factors in children, potentially worsening outcomes for those with heart disease.
• The American College of Cardiology (ACC) established a quality metric to identify and counsel overweight/obese children in cardiology clinics.
• A multicenter collaborative learning Quality Improvement (QI) Project utilized this metric via the ACC Quality Network (QNet).

Purpose of the Study:

• To increase the percentage of children (ages 3-18) with a Body Mass Index (BMI) above the 85th percentile receiving appropriate counseling during cardiology clinic visits.
• To evaluate the effectiveness of a multicenter collaborative learning approach in improving the implementation of the ACC BMI metric.

Main Methods:

• 32 participating centers submitted quarterly data on patient counseling rates to QNet.
• A Key Driver Diagram guided improvement efforts, with centers customizing interventions.
• Network-wide educational sessions facilitated shared learning and experience exchange. Statistical process control charts monitored progress.

Main Results:

• Data from 27,511 patient visits between April 2017 and September 2019 were analyzed.
• The overall counseling rate across participating centers reached 54%.
• The BMI counseling rate improved from 25% in Q2 2017 to 54% in Q3 2019, though individual center performance varied widely (10%-100%).

Conclusions:

• The overall rate of identifying and counseling overweight/obese children in ambulatory cardiology clinics remains low, with significant performance variation among centers.
• Collaborative learning approaches can effectively drive improvement and increase the implementation of quality metrics.
• Individual centers demonstrated improvement through this multicenter learning initiative, highlighting its potential for broader application.