Sanjeev Nanda
Objective: The purpose of this quality improvement initiative was to improve patients’ awareness and understanding of body mass index (BMI) and its healthcare implications.
Background: Obesity has reached epidemic levels nationwide and is tied with smoking as the leading cause of preventable death. The Division of General Internal Medicine (GIM) at Mayo Clinic has approximately 3,680 patient visits monthly. Over 50% of these visits are with patients with a BMI >25 (overweight-obese). However, only 20% of these visits had documentation of discussion regarding obesity/BMI. As such, a significant quality gap exists in terms of obesity awareness, discussion, and implementation of treatment options. Given that awareness is the pivotal first step in reducing obesityrelated risks factors, we utilized quality methods and metrics in order to investigate the etiologies for this vast awareness gap, hypothesized and implemented a potential intervention, and reassessed for improvement.
Design and methods: This study was designed as quality improvement initiative. A root cause analysis (5-Whys) was performed to determine why obesity was not being addressed during physician visits. Based on this analysis, we hypothesized that a brief intervention of a physician-led discussion would increase patients’ awareness and understanding of BMI. A pre- and post-intervention survey tool was utilized to measure baseline and subsequent understanding respectively. Participants included patients seen within GIM at Mayo Clinic.
Results: A total of 70 patients completed the physicianled discussion along with the pre- and post-intervention surveys. The mean age of the cohort was 58.82 ± 12.69 years, with 45 (65%) male and 25 (35%) female participants. The mean intervention time of the physician-led discussion was 3 minutes. The brief intervention led to statistically significant improvements in patient awareness and understanding of BMI, ability to calculate BMI, knowledge of BMI-associated health risks, and awareness of an online resource tool. Furthermore, as result of this intervention, 84% of patients stated that they were more motivated to lose weight.
Conclusion: This quality initiative demonstrates various clinically orientated applications of quality metrics and tools. In summary, when physicians actively engage patients in a discussion about BMI and weight loss, not only do patients become better informed about their personal health and associated risk factors, but they also become more motivated to lose weight.
