Year of Publication

2016

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Lynne Jensen

Clinical Mentor

Dr. Joan Bischoff

Committee Member

Dr. Sharon Lock

Abstract

Abstract

Study Purpose: To assess obesity screening and counseling in patients at annual wellness exams in an urban primary care clinic. Specific aims of the study: determine percentage of patients with documented body mass index (BMI), ICD-9/ICD-10 diagnosis of overweight or obesity, documentation of education or a follow-up plan for weight management, follow-up visit for weight loss and documentation by provider, and comparative analysis of co-morbidities and demographic variables during well-exam visits.

Target Population and Measures: Adults over the age of 18 in an urban primary care clinic with a BMI greater than 25 kilograms (kg)/meters squared (m2). BMI screening and counseling and/or referral to nutritionist or dietician provided in the primary care clinic electronic medical record (EMR) or after-visit summary (AVS).

Methods: Retrospective analysis of 200 patient medical records (PMR) in individuals between the ages of 18 and 89. The urban primary care clinic is associated with a large healthcare system. Records were randomly selected by the healthcare systems Office of Research Administration utilizing a Microsoft Excel randomized generator. Seven PMR’s were eliminated due to well-exam coding linked to laboratory visits. 193 records were reviewed during data collection and analyzed utilizing SPSS software.

Results: 96.4% had BMI documented during well-exam visits. 66.7% of individuals who were overweight and 62.8% individuals who were obese received counseling and/or education documented in the EMR. No overweight adults and only 16.3% of obese adults had ICD-10 diagnoses documented. Rates of most co-morbidities increased in a linear trend for healthy weight, overweight, and obese adults respectively. Counseling rates increased as number of co-morbidities noted increased, respectively.

Organizational Recommendation for Change: Weight management and/or healthy lifestyle education added to the AVS of the EMR in adults with BMI greater than 25 kg/m2. AVS are printed at the end of each patient visit and would provide a streamlined process to provide education on weight management, including diet and exercise, to adults.

Keywords: Obesity, overweight, body mass index, counseling, screening, adults, electronic medical record, and electronic health record.

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