ArticleLack of Diagnosis and Screening for Pediatric Obesity in the Retail Health Setting: Implications for Quality Improvement Measures
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INTRODUCTION
Childhood obesity is a major public health concern facing the United States, and it affects children at alarming rates. Centers for Disease Control and Prevention (CDC, 2018a) reports that 13.7 million children aged 2–19 years are obese. Since the 1970s, the number of children with obesity has tripled (CDC, 2018b). Healthy People 2020 (HP2020), the national framework for a healthier population, addresses specific objectives for nutrition and weight status uniquely related to children as areas
Study Design/Sample
This study uses a secondary analysis of data collected retrospectively from electronic health records (EHRs). The data were made available from patients presenting to Chicago–area retail health clinics from June 1, 2017, to November 30, 2017. Inclusion criteria included patients aged 3–18 years at the time of their encounter and presentation to the clinic for school or sports physicals. Patients younger than 3 years and older than 18 years and those presenting for reasons other than school and
RESULTS
The 6 months of data used in our analysis included 2,570 subjects who met the inclusion criteria for the study. Of these subjects, 2.0% (n = 53) were under the 5th BMI percentile, and 62.9% (n = 1,683) were between the 5th and 84th BMI percentile (see Table 1). The remaining 31% (n = 834) of subjects had a BMI of ≥85%, with overweight (n = 409) and obese (n = 425) subjects being nearly equal, 15.3% and 15.9%, respectively.
Over half of the subjects whose data were included here were male
DISCUSSION
The purpose of this study was to better understand the behaviors of nurse practitioners in screening and diagnosing overweight or obesity in children undergoing school and sports physicals. Key findings indicated that despite a high rate of BMI percentile documented in the EHR (96.1% of all subjects), 99% of subjects did not receive a formal obesity diagnosis, and 99% were missing screening measures. In addition, the rate of obesity in the study sample was 15.9%, which is higher than the HP2020
CONCLUSION
Childhood obesity rates continue to trend upward, despite the call to action in HP2020. In this study, the EHR autopopulated the BMI percentile for each patient, yet there was a significant lack of nutrition and physical activity screening noted in the EHR. There was also a critical deficiency in diagnosis for overweight and obese children. To meet the overarching goal of reducing the prevalence of overweight and obesity, it is imperative to find out why the diagnosis and management of at-risk
Jodie N. Guardi, Family Nurse Practitioner, Advocate Health Care, Aurora, IL.
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Cited by (0)
Jodie N. Guardi, Family Nurse Practitioner, Advocate Health Care, Aurora, IL.
Elizabeth Aquino, Assistant Professor and Director of the Masters Entry to Nursing Practice Program, School of Nursing, College of Science and Health, DePaul University, Chicago, IL.
Karen Larimer, Adjunct Professor, School of Nursing, College of Science and Health, DePaul University, Chicago, IL.
Jessica Bishop-Royse, Senior Research Methodologist, DePaul Faculty Scholarship Support Center, College of Liberal Arts and Social Sciences, DePaul University, Chicago, IL.
Shannon D. Simonovich, Assistant Professor, School of Nursing, College of Science and Health, DePaul University, Chicago, IL.
Conflicts of interest: None to report.