The Healthy Eating Active Living Total Health (HEALTH) Model Improves the Quality of Pediatric Obesity Prevention

Abstract

BACKGROUND: The prevalence of childhood obesity has tripled in the past 30 years. There are many published recommendations to address pediatric obesity, yet countless physicians are challenged by the time and resources required to provide obesity screening and counseling in a busy practice. OBJECTIVE: To determine the effects of a motivational interviewing (MI) program and an electronic health record (EHR) reminder system to improve physician performance in identifying and counseling patients about obesity prevention and management. METHODS: Baseline and two post‐intervention cohorts were created with patients, ages 5‐18 years, from 100 consecutive well child visits at an academic teaching practice in Feb 2014, Feb 2015, and Aug 2015. The HEALTH model was created to improve care by providing in‐room family education tools, provider training in MI, an evidence‐based pathway to standardize care, and family coaching between visits. The model was implemented using quality improvement methodology. A second intervention added an alert in the EHR to notify providers if a patient’s body mass index (BMI) was > 85%ile. Outcome measurements included documentation of BMI percentiles, identification of overweight/obesity in the problem list, quantity and quality of healthy lifestyle counseling, and recommending follow up for BMI monitoring per prevention guidelines. P‐values were calculated using Chi‐Squared or Fisher’s Exact tests. RESULTS: Post HEALTH implementation, physicians improved their identification of patients with elevated BMI, improved the quantity and quality of healthy lifestyle counseling, and increased compliance with prevention plus recommendations for follow up. Providers increased their rates of identifying and counseling patients with obesity from a baseline of 50% to 76% (HEALTH) to 85% (EHR alerts). Post HEALTH intervention, physicians increased counseling about screen time and sleep (p<0.001) while maintaining high rates of counseling about nutrition, exercise and minimizing sugary beverages. Providers increased documentation of a specific, individualized action plan from 33% of the time at baseline to 59% post HEALTH intervention (p<0.001). Physicians increased recommendations for patients with elevations in BMI post intervention (p<0.005). CONCLUSIONS: After implementation of the HEALTH model and electronic reminders, physicians significantly improved their performance in identifying and counseling patients with elevated BMI. They also increased performance in counseling abouthealthy lifestyle behaviors for patients of all BMI categories. The HEALTH quality improvement model combined with electronic alerts provides a means to implement evidence‐based obesity prevention guidelines into clinical practice.