Clinical practice and variation in care for childhood obesity at seven clinics in California

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3 Citations (Scopus)

Abstract

Background: The Healthy Eating Active Living TeleHealth Community of Practice is a virtual quality-improvement learning network of seven rural clinics in California. The goal of this network is to improve childhood obesity prevention and management practices at participating clinics. Aim Our objective is to describe clinical practices regarding weight assessment and nutrition and physical activity counselling at participating clinics before implementation of the quality improvement intervention. Methods: Participants were 2-11 year old children seen for well-child care in 2010. Telephone surveys of English and Spanish-speaking parents were conducted within three days of their child's well-child visit to determine the content of counselling during the visit regarding nutrition and physical activity. Medical record reviews were conducted to determine clinicians' assessment of weight status. Findings: Twenty-seven clinicians conducted 144 well-child visits included in the study. Body mass index (BMI) was documented in 71% of medical records. Fewer than 10% of medical records had documentation of weight category. Sixty-nine percent of parents received counselling on physical activity and 62% reported receiving counselling on fruit and vegetable intake. Parents were counselled less frequently on breakfast intake, sweetened beverages, television and family meals. Parents of overweight/obese children did not receive more counselling than parents of children with a healthy BMI. Clinician-level effects accounted for moderately large amount of variation in counselling, but accounted for smaller variation in documentation of BMI and weight category. There was high between-clinic variation in documentation practices, with 54% of the total variance for documentation attributable to clinic-level effects. Conclusions: Rural clinicians, like those elsewhere, do not uniformly assess BMI percentile or counsel families on behavioural risk factors for paediatric obesity. There exists considerable clinician-level variation in counselling practices and clinic-site level correlation in documentation practices related to BMI percentile and weight category.

Original languageEnglish (US)
Pages (from-to)335-344
Number of pages10
JournalQuality in Primary Care
Volume20
Issue number5
StatePublished - 2012

Fingerprint

Pediatric Obesity
Counseling
Documentation
Body Mass Index
Parents
Weights and Measures
Medical Records
Exercise
Quality Improvement
Nutrition Assessment
Breakfast
Telemedicine
Practice Management
Beverages
Television
Child Care
Telephone
Vegetables
Meals
Fruit

Keywords

  • Child
  • Education
  • Obesity
  • Quality improvement
  • Telemedicine

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this

@article{8380b3d4aa1b44cfbbc8bc04f05ee98f,
title = "Clinical practice and variation in care for childhood obesity at seven clinics in California",
abstract = "Background: The Healthy Eating Active Living TeleHealth Community of Practice is a virtual quality-improvement learning network of seven rural clinics in California. The goal of this network is to improve childhood obesity prevention and management practices at participating clinics. Aim Our objective is to describe clinical practices regarding weight assessment and nutrition and physical activity counselling at participating clinics before implementation of the quality improvement intervention. Methods: Participants were 2-11 year old children seen for well-child care in 2010. Telephone surveys of English and Spanish-speaking parents were conducted within three days of their child's well-child visit to determine the content of counselling during the visit regarding nutrition and physical activity. Medical record reviews were conducted to determine clinicians' assessment of weight status. Findings: Twenty-seven clinicians conducted 144 well-child visits included in the study. Body mass index (BMI) was documented in 71{\%} of medical records. Fewer than 10{\%} of medical records had documentation of weight category. Sixty-nine percent of parents received counselling on physical activity and 62{\%} reported receiving counselling on fruit and vegetable intake. Parents were counselled less frequently on breakfast intake, sweetened beverages, television and family meals. Parents of overweight/obese children did not receive more counselling than parents of children with a healthy BMI. Clinician-level effects accounted for moderately large amount of variation in counselling, but accounted for smaller variation in documentation of BMI and weight category. There was high between-clinic variation in documentation practices, with 54{\%} of the total variance for documentation attributable to clinic-level effects. Conclusions: Rural clinicians, like those elsewhere, do not uniformly assess BMI percentile or counsel families on behavioural risk factors for paediatric obesity. There exists considerable clinician-level variation in counselling practices and clinic-site level correlation in documentation practices related to BMI percentile and weight category.",
keywords = "Child, Education, Obesity, Quality improvement, Telemedicine",
author = "Ulfat Shaikh and Jasmine Nettiksimmons and Joseph, {Jill G} and Tancredi, {Daniel J} and Romano, {Patrick S}",
year = "2012",
language = "English (US)",
volume = "20",
pages = "335--344",
journal = "Quality in Primary Care",
issn = "1479-1072",
publisher = "University of Leicester",
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TY - JOUR

T1 - Clinical practice and variation in care for childhood obesity at seven clinics in California

AU - Shaikh, Ulfat

AU - Nettiksimmons, Jasmine

AU - Joseph, Jill G

AU - Tancredi, Daniel J

AU - Romano, Patrick S

PY - 2012

Y1 - 2012

N2 - Background: The Healthy Eating Active Living TeleHealth Community of Practice is a virtual quality-improvement learning network of seven rural clinics in California. The goal of this network is to improve childhood obesity prevention and management practices at participating clinics. Aim Our objective is to describe clinical practices regarding weight assessment and nutrition and physical activity counselling at participating clinics before implementation of the quality improvement intervention. Methods: Participants were 2-11 year old children seen for well-child care in 2010. Telephone surveys of English and Spanish-speaking parents were conducted within three days of their child's well-child visit to determine the content of counselling during the visit regarding nutrition and physical activity. Medical record reviews were conducted to determine clinicians' assessment of weight status. Findings: Twenty-seven clinicians conducted 144 well-child visits included in the study. Body mass index (BMI) was documented in 71% of medical records. Fewer than 10% of medical records had documentation of weight category. Sixty-nine percent of parents received counselling on physical activity and 62% reported receiving counselling on fruit and vegetable intake. Parents were counselled less frequently on breakfast intake, sweetened beverages, television and family meals. Parents of overweight/obese children did not receive more counselling than parents of children with a healthy BMI. Clinician-level effects accounted for moderately large amount of variation in counselling, but accounted for smaller variation in documentation of BMI and weight category. There was high between-clinic variation in documentation practices, with 54% of the total variance for documentation attributable to clinic-level effects. Conclusions: Rural clinicians, like those elsewhere, do not uniformly assess BMI percentile or counsel families on behavioural risk factors for paediatric obesity. There exists considerable clinician-level variation in counselling practices and clinic-site level correlation in documentation practices related to BMI percentile and weight category.

AB - Background: The Healthy Eating Active Living TeleHealth Community of Practice is a virtual quality-improvement learning network of seven rural clinics in California. The goal of this network is to improve childhood obesity prevention and management practices at participating clinics. Aim Our objective is to describe clinical practices regarding weight assessment and nutrition and physical activity counselling at participating clinics before implementation of the quality improvement intervention. Methods: Participants were 2-11 year old children seen for well-child care in 2010. Telephone surveys of English and Spanish-speaking parents were conducted within three days of their child's well-child visit to determine the content of counselling during the visit regarding nutrition and physical activity. Medical record reviews were conducted to determine clinicians' assessment of weight status. Findings: Twenty-seven clinicians conducted 144 well-child visits included in the study. Body mass index (BMI) was documented in 71% of medical records. Fewer than 10% of medical records had documentation of weight category. Sixty-nine percent of parents received counselling on physical activity and 62% reported receiving counselling on fruit and vegetable intake. Parents were counselled less frequently on breakfast intake, sweetened beverages, television and family meals. Parents of overweight/obese children did not receive more counselling than parents of children with a healthy BMI. Clinician-level effects accounted for moderately large amount of variation in counselling, but accounted for smaller variation in documentation of BMI and weight category. There was high between-clinic variation in documentation practices, with 54% of the total variance for documentation attributable to clinic-level effects. Conclusions: Rural clinicians, like those elsewhere, do not uniformly assess BMI percentile or counsel families on behavioural risk factors for paediatric obesity. There exists considerable clinician-level variation in counselling practices and clinic-site level correlation in documentation practices related to BMI percentile and weight category.

KW - Child

KW - Education

KW - Obesity

KW - Quality improvement

KW - Telemedicine

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