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The Importance of EHR Quality Measures & Adult Obesity


Julie is a 54-year-old woman who is 5'4" tall and weighs 177 lbs. She is postmenopausal, and her medical history consists of hypertension, type 2 diabetes, hypercholesterolemia, osteoarthritis of both knees, and depression. Julie's family physician calculates her BMI to be 30.4. Julie is obese. Her physician discusses this with her and establishes a follow-up plan.1

Which Adult Obesity Quality Measures Count for Meaningful Use (Stage 1 & Stage 2)

  • Adult Weight Screening and Follow-Up (NQF# 0421)
  • Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up (NQF# 0421; CMS69v7)

Measuring & Improving Adult Obesity Care: A Real Impact on Your Patients

  • A large prospective cohort study of adults aged 50-71 found that even when controlled for age, race/ethnicity, education, smoking status, activity levels, and alcohol consumption, when compared to those with a normal BMI (23.5-24.9):2
    • Obese men had 1.46 to 2.40 times the risk of death, and
    • Obese women had 1.51 to 2.76 times the risk of death.
  • A 15 year prospective follow-up study of 16,113 people aged 30-59 showed:3
    • A 1 kg increase in body weight increased the risk of cardiovascular mortality by 1%-1.5%
  • A meta-analysis of weight reduction and lipids and lipoproteins found:4
    • Each kilogram of weight lost was associated with a 0.05 mmol/L decrease in total cholesterol
    • Each kilogram of weight lost was associated with a 0.02 mmol/L decrease in LDL-C
    • Each kilogram of weight lost was associated with a 0.015 mmol/L decrease in triglycerides
  • A prospective analysis of 4,970 overweight individuals with diabetes followed for 12 years found:5
    • those who intentionally lost weight experienced a 25% reduction in mortality

Conclusion

Identifying and addressing Julie's obesity now can lead to significant improvements in many areas of her health. If Julie loses even a little bit of weight she can improve her chances of living a long, healthy life.

Clinical Quality Measure Information

Adult Weight Screening and Follow-Up

NQF# Description Numerator Denominator Exclusions
0421 Percentage of patients aged 18 years and older with a calculate BMI documented in the medical record, and if the most recent BMI is outside the parameters, a follow-up plan is documented. Patients with:
  • BMI calculated
  • Follow- up plan documented if BMI is outside parameters.
Patients
  • > 18 years of age
Patients with:
  • Documentation of over or underweight who are being managed by another provider
  • A terminal illness
  • Refusal to have BMI measured
  • Other reason BMI is not appropriate (must be documented in record)
  • Urgent or emergent medical needs where a delay in treatment would jeopardize the patient's health.

About National Quality Forum (NQF) Endorsement

Each of the Clinical Quality Measures has an NQF number, indicating that it has received endorsement from the National Quality Forum (NQF), a nonprofit organization with the mission to improve the quality of American healthcare. NQF uses a formal Consensus Development Process (CDP) to evaluate and endorse consensus standards, including performance measures. This process includes gathering input on performance measures from a wide variety of stakeholders including consumer organizations and health care providers.6

  1. Adapted from the following obesity; https://online.epocrates.com/u/2922211/Obesity+in+adults/Basics/Vignette Exit Disclaimer [online.epocrates.com] ; Accessed 02.01.12
  2. Adams, KF. Schatzkin, A., Harris, TB., Kipnis, V., Mouw, T., Ballard-Barbash, R., Hollenbeck, A., Letizmann, MF. "Overweight, obesity, and mortality in a large prospective cohort of persons 50-71 years old". The New England Journal of Medicine. 355 (2006): 763-68
  3. Jousilahti, P., Tuomilehto, J., Vartiainen, Pekkanen, J., Puskka, P. "Body weight, cardiovascular risk factors, and coronary mortality: 15 year follow up of middle-age men and women in eastern Finland". Circulation. 93 (1996): 1372-1379.
  4. Dattilo, AM., Kris-Etherton, PM. "Effects of weight reduction on blood lipids and lipoproteins: a meta-analysis". American Journal of Clinical Nutrition. 56 (1992): 320-8.
  5. Williamson, DE., Thompson, TJ. Thun, M., Flanders, D., Pamuk, E., Byers, T. "Intenational Weight Loss and Mortality Among Overweight Individuals with Diabetes". Diabetes Care. 23 (2000): 1499-1054
  6. http://www.qualityforum.org Exit Disclaimer [www.qualityforum.org] Accessed January 31, 2012

Produced by Meaningful Use Quality Workgroup - February 19, 2013

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