Abstract:

The ABP's Maintenance of Certification Part 4 has been a challenge for pediatricians who work in the inpatient setting. Four community pediatric hospitalists adapted the EQIPP: Nutritional Assessment of the Healthy and Chronically Ill Child course to the inpatient setting. BMIs were screened in patients 2 years and older whom were admitted to a nine bed pediatric unit in a community hospital.

All 4 physicians received MOC Part 4 credit and there was an increase in BMI screenings during the course period, but a return to baseline screenings soon after the course ended. This leads to questioning the sustainability of a single web-based QI course applied to the inpatient setting.

Methods:
A chart review was undertaken to examine documentation of a patient’s BMI; evidenced by plotting a patient’s BMI on the CDC’s body mass index-for-age percentiles for the appropriate gender. Charts were reviewed from Aug 2010 - Feb 2011. A total of 161 patients were included.

The 4 providers enrolled in the course and were considered to be the “EQIPP Member” cohort. The remaining 6 members were considered to be the “Non-EQIPP Member” cohort.

From Aug 2010 - Sept 30th 2010 (9 weeks) was used as a pre-intervention control group. Conscious screening for patient’s BMI lasted for 14 weeks beginning Oct 2010 and continued through Dec 2010. Jan 2011- Feb 26th 2011 (9 weeks) was a post-intervention period.

Results:
161 patients met the criteria to be included in the study population. The average age of all patients was 9.15 years old. There were 85 males and 79 females in the study.

BMIs plotted were expressed as a percentage of the total patients and were further divided into patients screened by an EQIPP Member. The average percentage for any provider plotting a BMI was 22.98% and EQIPP Members were responsible for 67.5% of those BMI’s plotted.

During the pre-intervention period, a total of 2 patients had their BMI’s plotted. Weeks 9 - 12 revealed that patients were exclusively plotted by EQIPP Members. The highest overall recorded BMI screening was on week 11 at 83%. Weeks 13 - 15 showed a transition from BMIs being plotted by only EQIPP Members to BMIs being plotted entirely by Non-EQIPP Members. Weeks 16 - 21 demonstrated a similar pattern of BMIs being plotted by only EQIPP Members with a return of patients being almost exclusively plotted by Non-EQIPP Members.

The post intervention period, showed a zero percentage of BMIs being plotted.

The total number of patients not screened was 63. On average 2 children per week missed having their BMI screened by EQIPP Members.

Discussion:
There was a strong trend for increasing the number of BMI screenings during the intervention period by both EQIPP Members and Non-EQIPP Members.

A focused discussion from a minority of pediatric hospitalists at a division meeting was able to influence the group. It's evident that a cultural shift took place within the group, as seen by increasing BMI screening in both groups.

Despite all 4 EQIPP Members receiving MOC part 4 credits for this web-based activity, there is evidence to show that BMI screening with this group has not been a long lasting or sustainable. Some challenges leading to a non-sustainable QI project include the artificial expiration date, lack of funds for providers to enroll into the course, questionable appropriateness of screening by some division members, and lastly questionable appropriateness of conducting screenings by nursing staff.

Keywords:

Maintenance of Certification, MOC, Part 4, EQIPP, Quality Improvement, QI, Obesity, Hospitalist, Inpatient.