May
1
Written by:
admin
5/1/2008 3:20 PM
We are implementing a simple PDSA for weight, height and waist measurement.
This utilises features of the PIP prompter program.
Here are the statistics as collected at baseline
Checking [HEIGHT, WEIGHT, WAIST]
Total patients checked = 4652
Measurement:HEIGHT [Patients Not passed Rules = 0 [0.00%]]
UpToDate Ovrdue NotDone Rule
--------------- --------------- --------------- ---------------
85 49 4213 [Two_Years]
22 38 5 Obesity [Six_Months]
8 13 64 18<=Age, AllVascularDisease [Twelve_Months]
2 6 11 18<=Age, CLD [Twelve_Months]
23 33 59 18<=Age, Diabetes [Twelve_Months]
3 2 12 18<=Age, HeartFailure [Twelve_Months]
0 0 3 Age<18, Diabetes [Six_Months]
0 0 1 18<=Age, ATSI [Twelve_Months]
143 141 4368 Totals :: Sum = 4652
UpToDate % Ovrdue % NotDon % Rule %
--------------- --------------- --------------- ---------------
2% 1% 97% [Two_Years]
34% 58% 8% Obesity [Six_Months]
9% 15% 75% 18<=Age, AllVascularDisease [Twelve_Months]
11% 32% 58% 18<=Age, CLD [Twelve_Months]
20% 29% 51% 18<=Age, Diabetes [Twelve_Months]
18% 12% 71% 18<=Age, HeartFailure [Twelve_Months]
0% 0% 100% Age<18, Diabetes [Six_Months]
0% 0% 100% 18<=Age, ATSI [Twelve_Months]
3.07% 3.03% 93.90% Totals :: Sum = 100%
Measurement:WAIST [Patients Not passed Rules = 0 [0.00%]]
UpToDate Ovrdue NotDone Rule
--------------- --------------- --------------- ---------------
3 0 4344 [Two_Years]
2 0 63 Obesity [Six_Months]
0 0 85 18<=Age, AllVascularDisease [Twelve_Months]
0 0 19 18<=Age, CLD [Twelve_Months]
1 5 109 18<=Age, Diabetes [Twelve_Months]
0 0 17 18<=Age, HeartFailure [Twelve_Months]
0 0 3 Age<18, Diabetes [Six_Months]
0 0 1 18<=Age, ATSI [Twelve_Months]
6 5 4641 Totals :: Sum = 4652
UpToDate % Ovrdue % NotDon % Rule %
--------------- --------------- --------------- ---------------
0% 0% 100% [Two_Years]
3% 0% 97% Obesity [Six_Months]
0% 0% 100% 18<=Age, AllVascularDisease [Twelve_Months]
0% 0% 100% 18<=Age, CLD [Twelve_Months]
1% 4% 95% 18<=Age, Diabetes [Twelve_Months]
0% 0% 100% 18<=Age, HeartFailure [Twelve_Months]
0% 0% 100% Age<18, Diabetes [Six_Months]
0% 0% 100% 18<=Age, ATSI [Twelve_Months]
0.13% 0.11% 99.76% Totals :: Sum = 100%
Measurement:WEIGHT [Patients Not passed Rules = 0 [0.00%]]
UpToDate Ovrdue NotDone Rule
--------------- --------------- --------------- ---------------
164 120 4063 [Two_Years]
22 39 4 Obesity [Six_Months]
8 22 55 18<=Age, AllVascularDisease [Twelve_Months]
2 7 10 18<=Age, CLD [Twelve_Months]
23 36 56 18<=Age, Diabetes [Twelve_Months]
3 5 9 18<=Age, HeartFailure [Twelve_Months]
0 0 3 Age<18, Diabetes [Six_Months]
0 0 1 18<=Age, ATSI [Twelve_Months]
222 229 4201 Totals :: Sum = 4652
UpToDate % Ovrdue % NotDon % Rule %
--------------- --------------- --------------- ---------------
4% 3% 93% [Two_Years]
34% 60% 6% Obesity [Six_Months]
9% 26% 65% 18<=Age, AllVascularDisease [Twelve_Months]
11% 37% 53% 18<=Age, CLD [Twelve_Months]
20% 31% 49% 18<=Age, Diabetes [Twelve_Months]
18% 29% 53% 18<=Age, HeartFailure [Twelve_Months]
0% 0% 100% Age<18, Diabetes [Six_Months]
0% 0% 100% 18<=Age, ATSI [Twelve_Months]
4.77% 4.92% 90.31% Totals :: Sum = 100%
Here is the PDSA outline and I have posted a word document as well.
Background
Red Book Guidelines for prevention of obesity and concomitant morbidity risks.
What to measure
1. Height
2. Weight
3. Waist circumference
4. Pubertal stage in children
When to measure
|
Risk Groups
|
Paediatric (<18yo)
|
Adult(>=18yo)
|
|
All Australians
|
2 years
|
2 years
|
|
Aboriginal and Torres Strait Islander peoples and those from Pacific islands
|
6 months
|
12 months
|
|
Middle Eastern and Mediterranean backgrounds
|
6 months
|
12 months
|
|
Existing diabetes or cardiovascular disease, stroke, gout, liver or gallbladder disease
|
6 months
|
12 months
|
|
Existing Obesity
|
6 months
|
6 months
|
Intervention
Preventive counselling and advice for physical activity and nutrition advice. Details on overweight and obesity management can be found in NHMRC Overweight and obesity in children and adolescents – a guide for general practitioners
www.health.gov.au/internet/wcms/Publishing.nsf/Content/obesityguidelines-guidelines-gp_guide.htm/$FILE/children_gp.pdf
PLAN
Aims
Implement red book guidelines for height, weight and waist measurement.
Implement these as patients present during routine practice.
How
Implement these via software assisted data collection sheets used prior to consultation and via prompts during consultation. Data is recorded into our practice software (Medical Director).
Identify Outcome/Change
Be able to record statistics regarding current recording of data for each of the different groups and intervals as specified in the Red Book Guidelines.
Limitations in design
Currently able to easily integrate within software parameters
1. Age
2. ATSI status
3. existing obesity
4. history of cardiovascular disease, stroke and chronic liver disease
Not able to distinguish
1. Middle Eastern and Mediterranean backgrounds
2. history of gout or gallbladder disease
Difficulties with staff implementing waist measurements pre-consultation meant waist only recorded if measured during consultation.
Not able to record pediatric pubertal stage within software.
Changes expected
Increased recording of Red Book guideline data
Increased utilization of features of medical electronic record for recording data
Integrate successful techniques for recording weight, height and waist measurement into routine medical practice.
Increase interventions for obese patients.
Cycle 2
Implementation of Weight and Height following Red Book Guidelines
Method
Install PIP Check Prompter on all participating doctors’ workstations.
Run application during consultation to receive prompts for preventive care items height, weight and waist measurement.
Print daily data collection sheets for staff at front desk to implement pre consultation measurements.
Record measurements in MDW during consultation and implement interventions if deemed appropriate.
Cycle 3
Implementation of Weight and Height following Red Book Guidelines
Ongoing refinement of Processes
Refine and enhance the pre consultation measurement of height, weight and waist to facilitate speed, usability for patients and staff. Try different methods.
Assessment of Change
Print statistics from Check Prompter and monthly throughout the PDSA cycles.
Observe for patient subgroups (Rules in PIP Check Prompter) which tend to be overlooked and make efforts to improve recording as per Red Book Guidelines.
Cycle 4
Implementation of Weight and Height following Red Book Guidelines
Assess Implementation of Red Book Guidelines for height, weight and waist within the practice over the course of the PDSA.
Areas for improvement.
Pre Consultation.
During Consultation.
Applicability to Other RBG Data
Other Red Book Guideline data collection that can be implemented / enhanced used methods discovered in this PDSA.