Research Activities, January 2012: Patient Safety and Quality: Medical residents can use quality improvement methods to promote obesity screening

Research Activities, January 2012: Patient Safety and Quality: Medical residents can use quality improvement methods to promote obesity screening

Medical residents can use quality improvement methods to promote obesity screening

Although traditionally excluded from quality improvement (QI) initiatives, more and more medical residents are being trained in the use of QI methods to analyze their practice. A new study found that a medical resident QI initiative to improve obesity screening in a primary care clinic not only increased the documentation of body mass index (BMI) in the patients' charts, but also promoted lifestyle counseling efforts.

After undergoing QI training, second-year residents created ways to streamline the way BMI documentation was collected. They also developed a variety of educational materials to be used as part of the screening initiative. Only 4 percent of patients seen in the clinic were at the BMI goal of less than 25. Despite the fact that many of the patients were obese, resident audits of charts revealed little obesity screening or calculation of BMI prior to the QI intervention.

During the initial 2 weeks of the intervention, documentation of height, weight, and BMI increased dramatically. BMI documentation declined from 79 percent after 2 weeks to 41 percent at 6 months. Nevertheless, at the end of 1 year, BMI documentation rates remained significantly higher (43 percent) compared to before the initiative (4 percent). Patients who had their BMI recorded by the resident were also more likely to receive lifestyle modification counseling (34 percent) than patients who didn't get their BMI documented in the chart (14 percent). BMI documentation, however, did not promote referral to a dietitian.

The study was supported in part by the Agency for Healthcare Research and Quality (T32 HS00084).
See "A resident-led quality improvement initiative to improve obesity screening," by Neda Laiteerapong, M.D., Chris E. Keh, M.D., Keith B. Naylor, M.D., and others in the American Journal of Medical Quality 26, pp. 315-322, 2011.