Utilizing Epic Best Practice Alerts and Televisits to Improve Access to Pediatric Obesity Care

Background: The US Preventative Task Force (2017) recommends 26 intensive lifestyle visits to improve pediatric obesity. Time constraints limit primary care pediatric providers from implementing intensive obesity care. A pediatric nurse practitioner designed a best practice alert imbedded into Epic® healthcare information systems throughout 14 hospital-owned pediatric primary care clinics aimed to improve obesity care delivery gaps. Alerts appear in Epic® charting during a well-child visit when a provider views a growth chart for a patient ages 6-18 years with a body mass index above or at the 95th percentile for age and sex, which is diagnostic for obesity. Alerts give providers an option to click an automatic referral pathway for interdisciplinary obesity care. The nurse practitioner simultaneously developed a telehealth clinic to deliver lifestyle counseling visits for providing efficient obesity care. Mixed methods including interviews, opinion surveys, electronic chart data reviews, a Likert-scaled provider telehealth visit satisfaction survey, and a modified family nutrition and physical activity tool measured for meaningful outcomes. Software technology platforms included SPSS® statistical software, SurveyMonkey®, Epic®, and SnapMD®. Fifty primary care providers received 1288 alerts to patients having obesity from June 1, 2019, through September 30, 2019, and referred 323 of those patients for endocrinology and telehealth visits. Thirty patients participated in 63 televisits. An increased frequency of low-fat milk consumption was the only significant health-promoting behavioral change when measured by Mann-Whitney U analysis. A post-intervention survey showed that 82% of responding providers (n = 17) agreed that the alerts and televisits are effective to increase obesity care access. The quality improvement initiative provided a promising model for a process change to improve pediatric obesity care practice in identifying pediatric patients at well visits having obesity and triggering a referral pathway for comprehensive, multidisciplinary care. The initiative can be strengthened by an alert allowing primary care providers to bypass specialty care evaluation in endocrinology and refer directly to intensive telehealth interventional lifestyles counseling when screening laboratory diagnostics are within normal limits. Closing obesity care delivery gaps using healthcare technology innovation like best practice alerts and televisits can benefit patient access and provider satisfaction.

Sarah Scheuermann (poster #65) discloses that she received a project grant from Sigma Theta Tau and had a stipend paid by her employer for tele-visits.