Leveraging clinical decision support system tools for childhood overweight/obesity management

Consistent with evidence-based care for pediatric overweight (BMI between 85th to 94th percentile) and obesity (BMI ≥ 95th percentile), a clinical decision support system (CDSS) OurPractice Advisory (OPA) was designed and implemented in 18 pediatric primary care clinics to support documenting elevated body mass index (BMI) on electronic health record (EHR) problem lists and ordering comorbidity screening labs. For those whom the OPA fired, we assessed the odds of problem list BMI documentation and comorbidity screening based on demographics and weight status and generated statistical process control charts to evaluate improvements in care processes. EHR data from 9,621 patients with overweight and obesity were collected from 2020 to 2023. Providers documented elevated BMI in the problem list for 44% of eligible encounters and performed comorbidity screening in 15% of eligible encounters. Providers were more likely to perform problem list BMI documentation for older children, non-Hispanic Black children, children with public insurance, and children with a higher BMI percentile. Providers were also more likely to perform comorbidity screening among the same groups. The mean percentage of patients with an elevated BMI diagnosis on their problem list increased from 9.2% to 64% and the mean percentage of patients who had comorbidity screening labs performed increased from 7.8% to 32%. The implementation of the CDSS intervention was associated with an increased likelihood of delivering evidence-based care processes.