Professor of Pediatrics Cincinnati Children's Hospital Medical Center cin, Ohio, United States
Background: While engagement in a pediatric weight management program (PWMP) has been shown to be protective against the development of eating disorders (ED), ED screening at new visit appointments is essential to ensuring that maladaptive attempts to lose weight are quickly identified and triaged. Medical providers at PWMPs are uniquely positioned to assist with this process through a structured ED screening protocol. Objective: The aim of this study was to increase physician execution of standardized ED screening , utilizing an adapted version of the Eating Disorder Diagnostic Scale–DSM 5 Version (EDDS-5). Target was to increase documentation from 37% to 75% of all eligible new patients ages 12-18 years seen in a tertiary PWMP from September 2022 to June 2023. Design/Methods: Using quality improvement methodology, interventions were grouped into three PDSA cycles including the implementation of: 1. EPIC SmartPhrases, 2. paper-and-pencil screeners, 3. electronic medical record (EMR) screeners. Screeners were administered in English. Weekly manual reviews of physician notes allowed for calculation of percentage of new patients who were screened. Data was plotted on a control chart (p-chart). Standard statistical process control methods were used to determine significance in change in performance. Results: Physician documentation rates of ED screening increased significantly from 37% to 80% (of 295 new patient visits). Screening increased for patients from both English and non-English speaking families (39%-88% and 17%-60%, respectively). New referrals to mental health providers increased from 13% to 19%.
Conclusion(s): Implementation of an automated ED screener resulted in increased documentation of eating disorder screening in PWMP as well as increased referrals to mental health providers. Future interventions will focus on ensuring equitable care by increasing rates of screening among patients from non-English speaking families and ensuring parity in screening processes between office and telehealth visits.
