Weight Assessment and Counseling for Children and Adolescents (NQF 0024)

Transcription

1 Weight Assessment and Cunseling fr Children and Adlescents (NQF 0024) EMeasure Name Weight Assessment and EMeasure Id Pending Cunseling fr Children and Adlescents Versin Number 1 Set Id Pending Available Date N infrmatin Measurement Perid January 1, 20xx thrugh December 31, 20xx Measure Steward Natinal Cmmittee fr Quality Assurance Endrsed by Natinal Quality Frum Descriptin The percentage f patients 2 17 years f age wh had an utpatient visit with a PCP r OB/GYN and wh had evidence f BMI percentile dcumentatin, cunseling fr nutritin and cunseling fr physical activity during the measurement year. Measure scring Prprtin Measure type Prcess Ratinale This measure assesses the percentage f age apprpriate patients wh had an utpatient visit with a PCP r OB/GYN and wh had evidence f a BMI percentile assessment, cunseling fr nutritin r cunseling fr physical activity. The prevalence f verweight and besity has increased sharply fr children ver the last 30 years: frm 5.0% t 13.9% fr thse aged 2 5 years; frm 6.5% t 18.8% fr thse aged 6 11 years; and frm 5.0% t 17.4% fr thse aged years. This increasing prevalence has had significant ecnmic ramificatins, with ecnmic csts crrelated t besity and related cmrbidities estimated at ver $70 billin, r 7% f the natinal health care budget. T address this prblem and its lng term implicatins effectively, prmtin f rutine physical activity and healthy eating and lifestyle changes are essential (CDC 2007). This measure is imprtant in effrts t imprve lng term health utcmes and quality f life. Clinical Recmmendatin Statement U.S. Preventive Services Task Frce (USPSTF): I Recmmendatin. Insufficient evidence t recmmend fr r against screening fr verweight in children and adlescents reflects the paucity f strng evidence f the effectiveness f interventins fr this prblem in the clinical setting. The American Academy f Pediatrics (AAP): The child s height, weight and percentiles fr age shuld be determined at the start f the physical examinatin. Because besity is strngly linked t hypertensin, BMI shuld be calculated frm the height and weight, and the BMI percentile shuld be calculated. Pr grwth may indicate an underlying chrnic illness. The American Medical Assciatin (AMA), Health Resurces and Services Administratin (HRSA), and Centers fr Disease Cntrl and Preventin (CDC): The Expert Cmmittee recmmends that physicians and allied healthcare prviders perfrm, at a minimum, a yearly assessment f weight status in all children, and that this assessment include calculatin f height, weight (measured apprpriately), and bdy mass index (BMI) fr age and pltting f thse measures n standard grwth charts.

2 The American Academy f Pediatrics and the American Cllege f Clinical Endcrinlgy (ACCE): The AAP and the ACCE recmmend and encurage pediatric prviders t screen children fr besity using BMI; examine verweight children fr besity related diseases; initiate weight management practices t imprve diet and physical activity habits; and increase frequency f visits t reinfrce behavir changes. Reference The Centers fr Disease Cntrl and Preventin (CDC): The CDC recmmends using the percentile BMI fr age and gender as the mst apprpriate and easily available methd t screen fr childhd verweight r at risk fr verweight. BMI is calculated by dividing the weight in kilgrams by the height in meters squared. Age and gender nrms fr BMI are readily accessible. BMI crrelates with adipsity and with cmplicatins f childhd verweight such as hyperchlesterlemia, hypertensin and later develpment f cardivascular disease. Althugh mre precise measures f lean bdy mass and bdy fat such as dual x ray absrptimetry (DEXA) may be apprpriate fr clinical studies, BMI nrms are particularly helpful fr screening in busy ffice practices and fr ppulatin assessment. U.S. Preventive Services Task Frce (USPSTF). Screening and interventins fr verweight in children and adlescents: recmmendatin statement. Rckville (MD): Agency fr Healthcare Research and Quality (AHRQ); p. 11. Natinal High Bld Pressure Educatin Prgram Wrking Grup n High Bld Pressure in Children. The furth reprt n the diagnsis, evaluatin, and treatment f high bld pressure in children and adlescents. Pediatrics Aug; 114(2 Suppl): AMA/HRSA/ CDC Expert Cmmittee n the Assessment, Preventin and Treatment f Child and Adlescent Overweight and Obesity. Recmmendatins n the assessment, preventin and treatment f child and adlescent verweight and besity. Chicag (IL): AMA Jun. 1. Drsey, K.B., C. Wells, H.M. Krumhlz, J.C. Cncat. Diagnsis, evaluatin, and treatment f childhd besity in pediatric practice. Arch Pediatr Adlesc Med July; 159: Definitins Baker, S., S. Barlw, W. Cchran, G. Fuchs, W. Klish, N. Krebs, R. Strauss, A. Tershakvec, J. Udall. Overweight children and adlescents: a clinical reprt f the Nrth American Sciety fr Pediatric Gastrenterlgy, Hepatlgy and Nutritin. J Pediatr Gastrenterl Nutr May; 40(5): Table f Cntents Ppulatin criteria 1 Ppulatin criteria 2 Ppulatin criteria 3

3 Data criteria (QDS Data Elements) Summary calculatin Please refer t the spreadsheet fr this measure fr detail regarding data criteria and cde lists. Ppulatin criteria 1 Initial Patient Ppulatin 1 = Denminatr = Numeratr 1 = Numeratr 2 = Numeratr 3 = Exclusins = Ppulatin criteria 2 AND: Patient characteristic: birth date (age) >=2 and <=16 years t expect screening fr patients within ne year after reaching 2 years until 17 years; AND: Encunter: encunter utpatient w/pcp & bgyn ; AND NOT: Diagnsis active: pregnancy ; AND NOT: Encunter: encunter pregnancy ; AND: Cmmunicatin t patient: cunseling fr nutritin ; AND: Cmmunicatin t patient: cunseling fr physical activity ; AND: Nne; Initial Patient Ppulatin 2 = Denminatr = Numeratr 1 = Numeratr 2 = Numeratr 3 = AND: Patient characteristic: birth date (age) >=2 and <=10 years t expect screening fr patients within ne year after reaching 2 years until 11 years; AND: Encunter: encunter utpatient w/pcp & bgyn ; AND NOT: Diagnsis active: pregnancy ; AND NOT: Encunter: encunter pregnancy ; AND: Cmmunicatin t patient: cunseling fr nutritin ; AND: Cmmunicatin t patient: cunseling fr physical activity ;

4 Exclusins = Ppulatin criteria 3 AND: Nne; Initial Patient Ppulatin 3 = Denminatr = Numeratr 1 = Numeratr 2 = Numeratr 3 = Exclusins = AND: Patient characteristic: birth date (age) >=11 and <=16 years t expect screening fr patients within ne year after reaching 12 years until 17 years; AND: Encunter: encunter utpatient w/pcp & bgyn ; AND NOT: Diagnsis active: pregnancy ; AND NOT: Encunter: encunter pregnancy ; AND: Cmmunicatin t patient: cunseling fr nutritin ; AND: Cmmunicatin t patient: cunseling fr physical activity ; AND: Nne; Data criteria (QDS Data Elements) Patient Ppulatin = "Patient characteristic: birth date using birth date cde list befre the beginning f the measurement perid ; Denminatr = All patients in the initial patient ppulatin; Encunter: encunter utpatient w/pcp & bgyn using encunter utpatient w/pcp & bgyn cde list gruping during the measurement perid ; Diagnsis active: pregnancy using pregnancy cde list gruping during the measurement perid ; Encunter: encunter pregnancy using encunter pregnancy cde list during the measurement perid ; Numeratr 1 = Physical exam finding: BMI percentile using BMI percentile cde list gruping during the measurement perid ; Numeratr 2 = Cmmunicatin t patient: cunseling fr nutritin using cunseling fr nutritin cde list gruping during the measurement perid ;

5 Numeratr 3 = Cmmunicatin t patient: cunseling fr physical activity using cunseling fr physical activity cde list gruping during the measurement perid ; Exclusins = Nne; Summary calculatin Calculatin is generic t all measures: Calculate the final denminatr by adding all that meet denminatr criteria. Subtract frm the final denminatr all that d nt meet numeratr criteria yet als meet exclusin criteria. Nte sme measures d nt have exclusin criteria. The perfrmance calculatin is the number meeting numeratr criteria divided by the final denminatr. Fr measures with multiple patient ppulatins, repeat this prcess fr each patient ppulatin and reprt each result separately. Fr measures with multiple numeratrs, calculate each numeratr separately within each ppulatin using the paired exclusin. Measure set CLINICAL QUALITY MEASURE SET