Jeremy Steglitz1, Deborah Edberg, Mary Sommers2, Mary R Talen2, Louise K Thornton3, Bonnie Spring4. 1. Department of Preventive Medicine, Northwestern University, 680 N Lake Shore Dr, Chicago, IL 60611, USA jeremy.steglitz@northwestern.edu. 2. Erie Family Health Center, Chicago, IL, USA. 3. Department of Preventive Medicine, Northwestern University, 680 N Lake Shore Dr, Chicago, IL 60611, USA Priority Research Centre for Translational Neuroscience and Mental Health, University of Newcastle, Australia. 4. Department of Preventive Medicine, Northwestern University, 680 N Lake Shore Dr, Chicago, IL 60611, USA.
Abstract
OBJECTIVE: Primary care clinicians are well-positioned to intervene in the obesity epidemic. We studied whether implementation of an obesity intake protocol and electronic health record (EHR) form to guide behavior modification would facilitate identification and management of adult obesity in a Federally Qualified Health Center serving low-income, Hispanic patients. MATERIALS AND METHODS: In three studies, we examined clinician and patient outcomes before and after the addition of the weight management protocol and form. In the Clinician Study, 12 clinicians self-reported obesity management practices. In the Population Study, BMI and order data from 5000 patients and all 40 clinicians in the practice were extracted from the EHR preintervention and postintervention. In the Exposure Study, EHR-documented outcomes for a sub-sample of 46 patients actually exposed to the obesity management form were compared to matched controls. RESULTS: Clinicians reported that the intake protocol and form increased their performance of obesity-related assessments and their confidence in managing obesity. However, no improvement in obesity management practices or patient weight-loss was evident in EHR records for the overall clinic population. Further analysis revealed that only 55 patients were exposed to the form. Exposed patients were twice as likely to receive weight-loss counseling following the intervention, as compared to before, and more likely than matched controls. However, their obesity outcomes did not differ. CONCLUSION: Results suggest that an obesity intake protocol and EHR-based weight management form may facilitate clinician weight-loss counseling among those exposed to the form. Significant implementation barriers can limit exposure, however, and need to be addressed.
OBJECTIVE: Primary care clinicians are well-positioned to intervene in the obesity epidemic. We studied whether implementation of an obesity intake protocol and electronic health record (EHR) form to guide behavior modification would facilitate identification and management of adult obesity in a Federally Qualified Health Center serving low-income, Hispanic patients. MATERIALS AND METHODS: In three studies, we examined clinician and patient outcomes before and after the addition of the weight management protocol and form. In the Clinician Study, 12 clinicians self-reported obesity management practices. In the Population Study, BMI and order data from 5000 patients and all 40 clinicians in the practice were extracted from the EHR preintervention and postintervention. In the Exposure Study, EHR-documented outcomes for a sub-sample of 46 patients actually exposed to the obesity management form were compared to matched controls. RESULTS: Clinicians reported that the intake protocol and form increased their performance of obesity-related assessments and their confidence in managing obesity. However, no improvement in obesity management practices or patientweight-loss was evident in EHR records for the overall clinic population. Further analysis revealed that only 55 patients were exposed to the form. Exposed patients were twice as likely to receive weight-loss counseling following the intervention, as compared to before, and more likely than matched controls. However, their obesity outcomes did not differ. CONCLUSION: Results suggest that an obesity intake protocol and EHR-based weight management form may facilitate clinician weight-loss counseling among those exposed to the form. Significant implementation barriers can limit exposure, however, and need to be addressed.
Authors: Gregory Makoul; Anjali Dhurandhar; Mita Sanghavi Goel; Denise Scholtens; Alan S Rubin Journal: J Gen Intern Med Date: 2006-07 Impact factor: 5.128