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I have chosen to analyze the research and study on Childhood Obesity: Can electronic medical records (EMRs), customized with clinical practice guidelines improve screening and diagnosis. The project was done to determine if customization would affect the outcome of prevention, screening, and treatment and improve the rate of diagnosis of obesity in children 7-18 years of age.
Statement of the Problem
The failure to achieve a decrease the child obesity in our nation that was outlined in 2010 by the U.S. Department of Health and Human Services, they have recently released the 2020 projections and objectives that will intensify the focus on primary care physicians and state agencies to attain this goal. Primary care practices are a profound part of identifying, preventing, and managing childhood obesity. Clinicians are being urged to record BMI’s on all patients, in cases of identifying obesity/overweight individuals they would provide educational instructions, counsel patients on nutrition, and weight maintenance.
Practitioners rarely record accurate BMI percentages for pediatric patients, instead they rely on physical appearance or regarded as a result of some other specified cause. This is important to health care because of the subsequent medical conditions such as; type II diabetes mellitus, hyperlipidemia, hypertension, sleep apnea, and orthopedic problems. Providers have stated that the barriers of diagnosing, and managing childhood obesity is lack of practice resources, time, reimbursement, family motivation, and family resources.
Purpose of Study
Childhood obesity and overweight is a priority health issue, in the United States 32% of children 2-19 being overweight and 18.7% age 6-19 being obese (Ogden, Carroll, Curtin, Lamb, & Flegal, 2010). The development of diseases due to obesity is rising as obesity in our children becomes more profound. Children who had percentiles of BMI in the index between the 95th and 98th became obese adults, a percentile higher than the 98th percentile was related to adult obesity 100% of the time In this study there was a retrospective review done in regards to prevention, screening, and diagnosis of obesity in children.
Data was collected and compared for BMI documentation. The purpose of the study was to determine whether EMR customization using evidence based practices introduced by the National Association of Pediatric Nurse Practitioners and Expert Panel guidelines for prevention of obesity would improve the rate of the diagnosis of childhood obesity (Savinon, Taylor, Mitchell, & Siegfried, 2012).
A quasi-experimental design was used comparing outcomes of a group with written records from September 1, 2009 through December 31, 2009 to those using EMR September1,2010 through December 31, 2010
In this study the hypothesis is based on a conceptual model. The use in the study of growth charts, scoring risk questionnaires, BMI documentation, diagnosis of overweight or obesity in each study individual. This data was able to provide guidelines with the ability to decrease the rate of obesity/overweight in children 2-19 if followed consistently.
Evidence-Based Practice Guidelines
The Health Eating and Activity Together (HEAT) clinical practice guideline developed by the National Association of Pediatric Nurse Practitioners (NAPNAP), and the Expert Panel recommendations were designed to provide practitioners with the most recent evidence based information to attack childhood obesity. Training of providers in the practice guidelines showed an improvement in confidence, ease, and frequency of obesity-related counseling, a structured training with tools for successful intervention. The study confirmed that the training with in office tools showed improvement in documentation and adherence to guidelines but not with just training alone. There was a profound improvement seen after 3 and 6 month intervals in documentation of BMI percentages. Exposure to the guidelines through structured training and in office tools proved that provider practices in assessment and management regarding overweight and obese patients was greatly improved.
There were several variables abstracted from the written records and EMR using a chart audit form: race, religion, ethnicity, gender, age, provider type, payer source, height, weight, and BMI, Blood pressure, screening tests for lipids, and diabetes, diagnosis for overweight or obese.
Statistically there were no significant variables differences in the demographics for each group. Race, gender, insurance status, and age were similar in both the written and electronic records. A larger amount of children with written records were African-American (53%) and male (58%).
Implications for Practices
Customizing EMR with clinical practice guidelines improved the use of recommendations for screening and identifying childhood obesity. Increasing people’s awareness and diagnosis will ultimately lead to better intervention and improved outcomes.
There were clear signs of increase in recording of BMI, completion of grow charts, growth charts, scoring questionnaires. Providers are trained and provided with in-office tools to make sure everyone is complying with the guidelines. The number of children diagnosed overweight or obese increased with electronic medical records. Increasing recognition and diagnosis will lead to a profound reduction in the rate of obesity in the future. It will also lead to improved interventions and improved outcomes for childhood obesity.
Authors; Savinon C. , DNP, FNP-BC’(Asst. Professor), Taylor-Smith J. PhD, RN, WHNP-BC, Canty-Mitchell J. PhD, RN (Professor), Blood-Siegfried, DNSc, CPNP (Associate Professor), (2012)
2012 Childhood Obesity: Can Electronic Medical