(19.07) Multi-Faceted Approach in a Residents-Run QI Project To Improve Documentation of Obesity in a Resident Continuity Clinic- A part of a National Level Project
Resident (Internal Medicine) Florida Atlantic University Boca Raton, Florida, United States
Introduction : Obesity is an epidemic in the United States and worldwide, which causes numerous chronicconditions. Per CDC, the prevalence of Obesity has increased from 30.5% to 41.9% and that of severe obesity increased from 4.7% to 9.2% in the last two decades. However, studies have demonstrated that Obesity and its care plan is sub-optimally documented by Clinical providers. As we found low rates of documentation of diagnosis of Obesity in our residents-run continuity clinic, we conducted a QI project to improve the documentation, being a part of a national level initiative.
Case(s) Description : The documentation in the clinic is done in EHR (Athena) in which BMIs are calculated automatically based on patients’ measured weight and height. We reviewed EHR data from September 2022 to March 2023, which showed that the documentation of Obesity as a diagnosis or problem in medical notes was only done in 40 % of all patients with Obesity (BMI of 30 or more). Subsequently a process map was created, and root cause analysis was done with residents, medical assistants (MAs), clinic manager and clinic director. Our AIM statement was to increase the documentation of obesity as a diagnosis to 60% from baseline 40%, over the six months. Using the prioritization matrix our first PDSA cycle was generated with interventions including electronically reminding the residents to document Obesity via weekly emails before their clinic week begins and creating standardized way of documentation that included BMI, grading, waist circumference and care plan. After 5 weeks of the cycle during which all the residents completed their 1 week of clinic in a 4+1 system, medical notes of all the patients with Obesity were independently reviewed.The percentage increased only to 46%. Further areas of improvement were identified leading to the development of a second PDSA cycle with additional interventionswhich included MAs to provide the residents with a Vitals sheet with BMI/ Waist circumference in itprior to seeing patients, and advertising about the project and the importance of documentation in an Academic Half Day when almost everyone in the residency program is present for academic presentations and discussions.This was conducted for 5 weeks and data was reviewed the same way as after the 1st PDSA cycle that showed 68.66% of obese patients had Obesity as diagnosis in their medical notes/ documents. This shows a significant increase from the baseline.
Discussion : Previous studies have shown that patients with obesity are more likely to have a management plan or to have obesity addressed in the future visits if Obesity is documented as a diagnosis ora problem in the problem list. Our project can be a good example of successful implementation of resident-run, team-based, multi-faceted QI project to improve documentation of Obesity care plan.This way, patients are more likely to have a documented plan with earlier intervention leading to optimization of care, better outcomes, and high value care.
