Parental reports more accurate than electronic health records in documenting child diet and exercise counseling
Thirty-two percent of children and adolescents between the ages of 2 and 19 are either obese or overweight. Since food intake and physical activity are the primary modifiable determinants of obesity, behavior and lifestyle modification are critical to obesity prevention and management. Various authorities recommend that physicians counsel parents during well-child visits on diet and physical activity—a practice that varies. Reports by parents about diet and exercise counseling of their children by pediatricians is somewhat more accurate than documentation of this counseling in the child's electronic health record (EHR), concludes a new study.
A team of researchers led by Ulfat Shaikh, M.D. of the University of California, Davis School of Medicine compared parental reports given immediately after the office visit to EHR documentation of the visit. The sensitivity of parental report was high (63 to 96 percent), but specificity was low (43 to 77 percent) because of parents' tendency to overreport counseling. The sensitivity of EHR documentation was generally low (40 to 53 percent) except for discussion of screening time (92 percent) and physical activity (88 percent). EHRs also had poor specificity (42 percent and 21 percent, respectively, for screening time and physical activity). EHR documentation may suffer from information bias, suggest the researchers, because it tends to underestimate the discussion of many topics related to weight and nutrition and its potential to significantly overestimate counseling on certain topics specific to the design of local EHR templates.
The findings were based on analysis of audiotapes of the clinical sessions in which 38 physicians and parents of 198 children participated and the EHR documentation of the visits. The study was supported in part by the Agency for Healthcare Research and Quality (HS18567).
See "Accuracy of parental report and electronic health record documentation as measures of diet and physical activity counseling," by Ulfat Shaikh, M.D., Jasmine Nettiksimmons, M.A., Robert A. Bell, Ph.D., and others in Academic Pediatrics 12, pp. 81-87, 2012.