Electronic Tools to Assist With Identification of and Counseling for Overweight Patients

Overweight adults (Body Mass Index [BMI] 25-29.9) are at high risk for developing obesity, but rates of physician identification and counseling of overweight adults are low. Alerts and tools embedded in the electronic medical record have shown promise in enhancing quality improvement efforts.

Our aim is to design and assess the impact of an electronic alert and tool set to assist with identification and counseling of overweight patients with a BMI 27-29.9. Although the category of overweight patients spans BMI 25-29.9, we are including only patients with BMI 27-29.9 in order to focus resources on the most at-risk pre-obese population.

We will develop a tool set including the following components: automatic calculation of BMI, alert for overweight status, counseling template for weight loss goal-setting, linkage to referral options, and access to relevant patient handouts. Physicians in the Northwestern Memorial Faculty Foundation General Internal Medicine (NMFF GIM) practice who consent to participate in the study will be randomized into two groups, with one group of physicians receiving access to these tools. The other group of physicians will continue to provide their usual care for overweight patients. Outcome measures will include the following: tool usage; documentation of overweight in the problem list, encounter diagnosis, or note text; counseling for overweight and documentation of specific behavioral goals. Measures will be obtained via retrospective chart review.

Inclusion criteria

(physicians):

• Consenting physicians from the Northwestern Memorial General Internal Medicine (NMFF GIM) practice

Exclusion criteria

(physicians):

• Study investigators will be excluded from participation (Dr. David Baker, Dr. Joyce Tang)

Inclusion criteria

(patients):

• Adults ages 18-65 seen at the NMFF GIM who are patients of consenting physicians
• Have at least one appointment at the NMFF GIM clinic between 9/1/09-2/28/10
• Body mass index (BMI) 27-29.9 at one or more visits between 9/1/09-2/28/10

Exclusion criteria

(patients):

• Patients without at least one recorded height measurement from any prior visit or without weight information from a visit within the 6 month target window will be excluded due to inability to calculate BMI.