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The Importance of EHR Quality Measures & Childhood Obesity


Jack is a 6-year-old boy who eats a lot of prepackaged foods low in nutrients and high in calories and plays lots of video games. At Jack's most recent visit to his pediatrician his height was 3'8" and his weight was 53 lbs. With a BMI of 19.2 kg/m2, Jack is obese at the 97th percentile. Jack's pediatrician advised Jack and his parents to eat at least 5 servings of fruits and vegetables a day, eat together as a family, and to engage in physical activity for at least an hour a day.1

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

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

  • A study that abstracted height and weight measurements from the records of 854 subjects found that after 6 years of age, the probability of obesity in adulthood exceeded 50% for obese children (BMI . 85th percentile), as compared with about 10% for non-obese children (BMI < 85th percentile).2
  • The NHLBI Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents note that atherosclerosis starts in childhood and the presence of obesity is highly correlated with the development of other risk factors, including hyperlipidemia and hypertension, and subsequent morbidity and mortality from cardiovascular disease.3
    • A 1 kg increase in body weight increased the risk of cardiovascular mortality by 1% ‐ 1.5%
  • A cross-sectional study using 2008 DocStyles survey data found only 50% of pediatricians (n=250) and 22% of general practitioners with pediatric patients (n=621) reported using BMI-for-age. About half of pediatricians and general practitioners reported counseling all patients on physical activity, TV viewing time, energy dense foods, fruits and vegetables, and sugar-sweetened beverages.4 4
  • BMI plotting is associated with higher overweight/obesity recognition among visits of children with a BMI in the 85th to 94th percentile range. 5
    • Visits that included BMI plotting (n=6) identified 66.7% of children that percentile range as obese, compared to only 24.4% of those that did not plot BMI (n=86).

Conclusion

Recognizing Jack's obesity now and being frank with his family could markedly reduce his chances of suffering diabetes, vascular disease, or other complications of adult obesity.

Clinical Quality Measure Information

Body Mass Index (BMI) 2 through 18 Years of Age

NQF# Description Numerator Denominator Exclusions
0024 Percentage of children, 2 through 18 years of age, whose weight is classified based on BMI percentile for age and gender Number of Children:
  • Aged 2-18, &
  • Had well-child visit, &
  • Were classified based on BMI
Number of Children:
  • Aged 2 ‐ 18 &
  • Well child visits in measurement period
Exclusions
  • None

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. Based the case study contained in "Illustrated Guide to Good Nutrition: Food Choices That Promote Health and Weight Management in Children" CME http://www.medscape.org/features/slideshow/749584#2 Exit Disclaimer [www.medscape.org]
  2. Whitaker, R., Wright, J., Pepe, M., Seidel, K., Dietz, W. "Prediction obesity in young adulthood from childhood and parental obesity". New England Journal of Medicine. 337. 13 (1997): 869-73
  3. National Heart Lung and Blood Institute. "Expert panel in integrated guidelines for cardiovascular health and risk reduction in children and adolescents: Summary report". 2011:http://www.nhlbi.nih.gov/guidelines/cvd_ped/peds_guidelines_sum.pdf
  4. Wethington, H., Sherry, B., Polhamus, B. "Physician Practices related to use of BMI-for-age and counseling for childhood obesity prevention: A cross-sectional study". BMC Family Practice. 12. 80 (2011). 1-9.
  5. Barlow, S., Bobra, S., Elliott, M., Brownson, R., Haire-Joshu, D. "Recognition of childhood overweight during health supervision visits: does BMI health pediatricians?". Obesity. 15. 1. (2007): 225-32.
  6. http://www.qualityforum.org Exit Disclaimer [www.qualityforum.org] Accessed January 31, 2012

Produced by Meaningful Use Quality Workgroup ‐ March 22, 2013

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