Improving Documentation of Assessment and Plan for Obesity in Resident Primary Care Panels

From the 2023 HVPA National Conference

Sara Saliba MD (Cleveland Clinic Foundation), Hardik Patel DO, Osamah Badwan MD, Jacqueline Baikovitz MD, Nicole Farha MD, Connor Jaggi MD, Sarah Khan MD, Ian Persits DO, Fadi Toro MD, Jessica Donato MD

Background:
More than one billion people globally have obesity with significant health implications, many of which can be prevented or mitigated with obesity management. Despite this, obesity is often not addressed, even after the development of complications. Primary care providers play a crucial role in the early identification of obesity and initiation of evidence-based treatment. Our resident-led quality improvement (QI) project sought to increase the percentage of patients with obesity (defined as body mass index (BMI) greater than or equal to 30kg/m2) with a documented assessment and plan (A&P) for obesity by 30% within 9 months in the primary care panels of a group of internal medicine residents.

Methods:
The primary care panels of eight residents across four ambulatory sites were included. Data on the frequency of obesity-related A&P documentation for patients with obesity were obtained via manual chart review in Epic. Baseline data was collected via sampling of patients within these panels seen for annual physical exams and routine follow-up visits in the prior three months. Using process mapping and fishbone diagram tools, we determined the root causes of low obesity documentation rates in the A&P section of primary care notes for patients with obesity: addressing but not documenting obesity, and prioritization of other visit problems over obesity. In order to focus on the former, the resident clinic note template was modified to include BMI in the “Health Maintenance” section as a prompt to identify and document obesity in the A&P.

Results:
At baseline, 62.5% of patients with obesity (25/40) had an obesity-related A&P documented. The average BMI of this cohort of patients was 38.5kg/m2 and the average age was 54.3 years. This cohort consisted of 28 women and 12 men. Post-intervention data revealed 81.4% (48/59) of patients with obesity had an obesity-related A&P documented and interventions were implemented for these patients including lifestyle behavioral counseling (39.6%), prescription of anti-obesity medications (31.3%), and weight management referrals (29.2%).

Discussion:
We have designed a low-effort, high-impact intervention to help prompt clinicians to address and document obesity. Benefits were seen in terms of documentation capture and patient-related clinical plans.

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