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  • Measure Summary
  • NQMC:010410
  • Jan 2015

Pediatric preventive care: percentage of pediatric patients age 3 to 17 years who have had an overweight/obesity assessment and if BMI percentile is greater than or equal to 85 have appropriate documentation of counseling for physical activity and nutrition.

MN Community Measurement. Data collection guide: pediatric preventive care: overweight counseling 2015 (01/01/2014 to 12/31/2014 dates of service). Minneapolis (MN): MN Community Measurement; 2015. 65 p.

View the original measure documentation External Web Site Policy

This is the current release of the measure.

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percentage of pediatric patients age 3 to 17 years who have had an overweight/obesity assessment and if body mass index (BMI) percentile is greater than or equal to 85 have appropriate documentation of counseling for physical activity and nutrition.

Rationale

The number of United States children and adolescents who are overweight or obese continues to rise (Ogden et al., 2002). According to the 2007 to 2008 National Health and Nutrition Examination Survey, nearly 17% of children ages 2 to 19 are obese and almost 32% are overweight or obese (Institute of Medicine [IOM], 2010).

In 2009, the body mass index (BMI) documentation rate reported by the National Committee for Quality Assurance (NCQA) (2010) was 35% for commercially insured patients and 30% for Medicaid patients.

Bright Futures guidelines reports that although a child's weight status is the result of a number of factors (genes, metabolism, height, behavior and environment) working together, two of the most important determinants of weight status are nutrition and physical activity. Children older than two years who are between the 85th and 95th percentile of BMI need a second-level assessment and screening, and treatment which includes interventions focused on dietary changes/nutrition and physical activity.

Pilot testing of measure with 13 medical groups representing 116 clinics and 42,906 patients demonstrated that participating clinics are successfully assessing their patient population for obesity, with the prevalence of BMI percentile greater than 85 at 27.4% (overweight 14.8%, obese 12.6%) but demonstrated opportunity for improvement and variability among practices for providing counseling to overweight children with an overall average rate of 68.3%.

Evidence for Rationale

Institute of Medicine (IOM). Bridging the evidence gap in obesity prevention: a framework to inform decision making. Washington (DC): National Academies Press; 2010 Apr. 4 p.

MN Community Measurement. Data collection guide: pediatric preventive care: overweight counseling 2015 (01/01/2014 to 12/31/2014 dates of service). Minneapolis (MN): MN Community Measurement; 2015. 65 p.

National Committee for Quality Assurance (NCQA). The state of health care quality, 2010. Washington (DC): National Committee for Quality Assurance (NCQA); 2010.

Ogden CL, Flegal KM, Carroll MD, Johnson CL. Prevalence and trends in overweight among US children and adolescents, 1999-2000. JAMA. 2002 Oct 9;288(14):1728-32. PubMed External Web Site Policy

Primary Health Components

Obesity; overweight; body mass index (BMI); counseling; nutrition; physical activity; children; adolescents

Denominator Description

Patients who meet each of the following criteria are included in the denominator:

  • Patient was age 3 years at the start of the measurement period to 17 years at the end of the measurement period.
  • Patient was seen by an eligible provider in an eligible specialty face-to-face at least once during the measurement period for a well-child visit as identified using Current Procedural Terminology (CPT) codes.
  • Patient had body mass index (BMI) percentile greater than or equal to 85 according to Centers for Disease Control and Prevention (CDC) BMI percentile calculation formula.

See the related "Denominator Inclusions/Exclusions" field.

Numerator Description

Percentage of patients age 3 to 17 years with a body mass index (BMI) percentile greater than or equal to 85 who have documentation of both physical activity and nutrition discussion, counseling or referral in the medical record documented during the well-child preventive care visit (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

MN Community Measurement (MNCM) conducts validity testing to determine if quality measures truly measure what they are designed to measure, and conducts reliability testing to determine if measures yield stable, consistent results. Validity testing is done to see if the concept behind the measure reflects the quality of care that is provided to a patient and if the measure, as specified, accurately assesses the intended quality concept. Reliability testing is done to see if calculated performance scores are reproducible.

Evidence for Extent of Measure Testing

MN Community Measurement. Measure testing. [internet]. Minneapolis (MN): MN Community Measurement; [accessed 2015 Nov 12].

State of Use

Current routine use

Current Use

External oversight/State government program

Internal quality improvement

Measurement Setting

Ambulatory/Office-based Care

Professionals Involved in Delivery of Health Services

Advanced Practice Nurses

Physician Assistants

Physicians

Least Aggregated Level of Services Delivery Addressed

Clinical Practice or Public Health Sites

Statement of Acceptable Minimum Sample Size

Specified

Target Population Age

Age 3 to 17 years

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Health and Well-being of Communities
Person- and Family-centered Care
Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Getting Better

Living with Illness

Staying Healthy

IOM Domain

Effectiveness

Patient-centeredness

Case Finding Period

Measurement period will be a fixed 12-month period: January 1 to December 31

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Diagnostic Evaluation

Encounter

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
Patients who meet each of the following criteria are included in the denominator:

  • Patient was age 3 years at the start of the measurement period to 17 years at the end of the measurement period.
  • Patient was seen by an eligible provider in an eligible specialty face-to-face at least once during the measurement period for a well-child visit as identified using Current Procedural Terminology (CPT) codes. Refer to Table 1 in the original measure documentation for CPT codes identifying well-child visits.
  • Patient had body mass index (BMI) percentile greater than or equal to 85 according to Centers for Disease Control and Prevention (CDC) BMI percentile calculation formula.

Exclusions
Patients who are pregnant. The following codes can be used to determine pregnancy.

  • International Classification of Diseases, Ninth Revision (ICD-9) code range from 630 to 679.1 (complete code range). Refer to the tables located in the Data Collection Guide Appendices of the original measure documentation for more detailed information about how to identify patients who meet inclusion criteria using ICD-9 codes.
  • V22.0 to V28.9 normal pregnancy, high risk pregnancy or encounter antenatal screening. Refer to Table 2 in the original measure documentation for codes that indicate delivery.

Note: Not all of the codes are applicable to patients aged 12 to 17.

Exclusions/Exceptions

Medical factors addressed

Numerator Inclusions/Exclusions

Inclusions
Percentage of patients age 3 to 17 years with a body mass index (BMI) percentile greater than or equal to 85 who have documentation of both physical activity and nutrition discussion, counseling or referral in the medical record documented during the well-child preventive care visit

Note: Nutrition documentation includes any of the following:

  • Discussion of current nutrition behaviors (e.g., eating habits, dieting behaviors)
  • Checklist indicating nutrition addressed
  • Counseling or anticipatory guidance for nutrition
  • Provided educational materials on nutrition
  • Referral for any of the following: nutritional education, weight management classes, medical nutritional therapy, nutritional counseling with dietician, obesity counseling

Physical activity documentation includes any of the following:

  • Discussion of current physical activity behaviors (e.g., exercise routine, participation in sports activities, exam for sports participation)
  • Checklist indicating physical activity addressed
  • Counseling or anticipatory guidance for physical activity
  • Provided educational materials on physical activity
  • Referral for any of the following: exercise classes, exercise counseling, obesity counseling

Exclusions
Unspecified

Numerator Search Strategy

Fixed time period or point in time

Data Source

Administrative clinical data

Electronic health/medical record

Paper medical record

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

2015 Pediatric Preventive Care: Overweight Counseling Measure Flow Chart

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

Internal time comparison

Original Title

Pediatric preventive care: overweight counseling 2015.

Measure Collection Name

Pediatric Preventive Care

Submitter

MN Community Measurement - Health Care Quality Collaboration

Developer

MN Community Measurement - Health Care Quality Collaboration

Funding Source(s)

Unspecified

Composition of the Group that Developed the Measure

Unspecified

Financial Disclosures/Other Potential Conflicts of Interest

Unspecified

Adaptation

This measure was adapted from the National Committee for Quality Assurance (NCQA) measure for Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC). Specifically, the numerator definitions for counseling for nutrition and physical activity are aligned and were adapted from NCQA's measure.

Date of Most Current Version in NQMC

2015 Jan

Measure Maintenance

Unspecified

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

Source(s)

MN Community Measurement. Data collection guide: pediatric preventive care: overweight counseling 2015 (01/01/2014 to 12/31/2014 dates of service). Minneapolis (MN): MN Community Measurement; 2015. 65 p.

Measure Availability

Source available from the MN Community Measurement Web site External Web Site Policy.

For more information, contact MN Community Measurement at 3433 Broadway St. NE, Broadway Place East, Suite #455, Minneapolis, MN 55413; Phone: 612-455-2911; Web site: http://mncm.org External Web Site Policy; E-mail: info@mncm.org.

NQMC Status

This NQMC summary was completed by ECRI Institute on December 4, 2015. The information was verified by the measure developer on February 16, 2016.

Copyright Statement

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.

This measure is subject to review and may be revised or rescinded at any time by MN Community Measurement (MNCM). The measure may not be altered without the prior written approval of MNCM. Measures developed by MNCM, while copyrighted, can be reproduced and distributed without modification for noncommercial purposes (e.g., use by health care providers in connection with their practices). Commercial use is defined as the sale, license, or distribution of the measure for commercial gain, or incorporation of the measure into a product of service that is sold, licensed or distributed for commercial gain. Commercial use of the measure requires a license agreement between the user and MNCM.

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