Project Details - Ended
- Grant Number:R18 HS018157
- Funding Mechanism:
- AHRQ Funded Amount:$1,191,633
- Principal Investigator:
- Project Dates:9/30/2009 to 3/31/2013
- Care Setting:
- Medical Condition:
- Type of Care:
- Health Care Theme:
The prevalence of obesity has doubled over the past two decades, with two-thirds of the adult population now overweight and one-third obese. Routine ambulatory care encounters present an opportunity to introduce lifestyle changes with patients and discuss options of medical and surgical treatments. However, despite the availability of published guidelines on preventing, diagnosing, and treating obesity, most clinicians have been slow to respond to this public health problem.
This project developed a set of nine quality measures to evaluate obesity care based on the National Heart, Lung, and Blood Institute (NHLBI) guidelines. Natural language processing was used to automatically extract electronic medical record (EMR) data for the measures. This methodology was implemented to comprehensively assess the quality of adult obesity care in primary care settings.
The specific aims of this project were as follows:
- Develop obesity care quality measures based on updated NHLBI guidelines to evaluate obesity care performance in primary care.
- Use comprehensive EMR data to develop and validate an automated (generalizable and scalable) method for applying the measures identified in the first aim.
- Apply the method developed in the second aim to assess ambulatory obesity care quality in two distinct health plans representing diverse patient populations and care practices.
- Evaluate the association between measures of obesity guideline adherence to recommended obesity care processes and clinical outcomes and provider characteristics.
A retrospective analysis was done of EMR data from a mid-sized health maintenance organization and a consortium of safety-net clinics located in the Pacific Northwest using the new tool. The measures were compared against chart review of more than 900 patients to assess accuracy. Outcomes associated with the delivery of the recommended care were assessed.
EMR-based advice and diet and exercise plan measures performed best relative to the reference standard. Waist circumference and food and exercise diary education measures occurred too infrequently and so were not able to be evaluated well in this project. The project team determined that documentation of body mass index, readiness, and followup visit measures will need further work to resolve discrepancies between the EMR and chart review measures. A small but significant association was noted between guideline-recommended care and weight loss in patients who were overweight or obese.
Future research in this area would involve determining which, if any, EMR-based measures need refining of specifications to identify measures of interest more accurately, and which perform better in terms of locating information that is less accessible to manual chart reviewers.