Implementation of clinical practice guidelines for pediatric weight management

Abstract

Objective: To evaluate the effect of computer-assisted decision tools that standardize pediatric weight management in a large, integrated health care system for the diagnosis and management of child and adolescent obesity.

Study design: This was a large scale implementation study to document the impact of the Kaiser Permanente Southern California Pediatric Weight Management Initiative. An average of 739, 816 outpatient visits per year in children and adolescents from 2007 to 2010 were analyzed. Height, weight, evidence of exercise and nutrition counseling, and diagnoses of overweight and obesity were extracted from electronic medical records.

Results: Before the initiative, 66% of all children and adolescents had height and weight measured. This increased to 94% in 2010 after 3 years of the initiative (P < .001). In children and adolescents who were overweight or obese, diagnosis of overweight or obesity increased significantly from 12% in 2007 to 61% in 2010 (P < .001), and documented counseling rates for exercise and nutrition increased significantly from 1% in 2007 to 50% in 2010 (P < .001).

Conclusions: Computer-assisted decision tools to standardize pediatric weight management with concurrent education of pediatricians can substantially improve the identification, diagnosis, and counseling for overweight or obese children and adolescents.

Figure 1

Schematic of the KPSC Pediatric Weight Management Initiative.

Figure 2

Frequency of measurement of BMI, diagnosis of overweight and obesity, and exercise and nutrition counseling. The KPSC Pediatric Weight Management Initiative began in 2008. Visit rates are shown to illustrate that changes are not caused by increases in patient visits in the period of the initiative.