6 - Improving Care for Patients with Elevated BMI

Poster Number: 6
Publication Number: 6.2800

Background: The prevalence of elevated Body Mass Index (BMI) among children has increased rapidly, especially since the COVID-19 pandemic. Health consequences include dyslipidemia, abnormal glucose metabolism and metabolic dysfunction-associated steatotic liver disease. The American Academy of Pediatrics published guidelines in 2023 around comprehensive primary care management of pediatric obesity. Implementing these guidelines in pediatric practices remains challenging.

Objective: To improve primary care management of patients 10-22 years old with BMI > 95th percentile through laboratory evaluation, motivational interviewing (MI), referrals to subspecialties and comprehensive weight management programs and providing resources on nutrition and exercise (Figure 1).

Design/Methods: Iterative Plan-Do-Study-Act (PDSA) cycles were carried out over a six-month period. Cycles included: 1) Clinic-wide email reviewing comprehensive management of elevated BMI, 2) training on MI 3) electronic medical record (EMR) “Smartphrases” with MI strategies and guides for laboratory assessment, 4) Smartphrases with nutrition and physical activity resources in the After Visit Summary (AVS), 5) reminder of available Smartphrases through placards placed on clinic computers, 6) posting the laboratory algorithm in clinic and 7) posters in exam rooms promoting nutrition and activity. Outcomes, obtained from monthly chart reviews, included appropriate collection of screening labs, documentation of MI, referrals and provision of resources for families in the AVS.

Results: MI usage increased from a baseline of 0% to 41%, which was the greatest increase of all the outcomes assessed. Use of AVS handouts rose from 4 to 22%. Appropriate lab screening increased from 67% to 93%. Referrals placed increased from 22% to 59%. Reminder placards placed on computers had a large effect on MI usage and laboratory evaluations (Figure 2).

Conclusion(s): Interventions and comprehensive care for elevated BMI, aligned with AAP recommendations, can be feasibly implemented in pediatric primary care. Placards on computers are effective reminders. The AVS is an optimal place to include resources, however it remains under-utilized by providers. Dedicated time to learn MI in clinic can increase MI use in visits. Challenges include time allotted for visits, different practice patterns and maintaining interventions after the project. Future efforts include improving appropriate follow up and coordination both within primary care and subspecialty centers, and automating EMR order sets.