Clothier N, Marvel K, Cruickshank C. Does presenting patients’ BMI
increase documentation of obesity?

Med Educ Online [serial online] 2002;7:6. Available from URL

http://www.med-ed-online.org

Study Design: A pre-post control group design
was used.⁶ Participants were randomly assigned to
either an experimental group or a control group, with
matching for level of experience (that is an equal
number of first-, second-, and third-year residents
were represented in both groups). The study was
reviewed and approved by the Institutional Review
Board.

Intervention: Prior to the intervention, all
participants attended a 45-minute training session on
the definition, calculation, and interpretation of the
BMI. Using a written post-test, each participant
confirmed and documented that the educational
information had been reviewed and understood.
Other than the special BMI training session,
physicians did not receive additional exposure to the
recognition of obesity beyond the traditional
residency curriculum. Following the BMI training,
the experimental group physicians were provided the
BMI on the list of vital signs, along with height,
weight, blood pressure, and temperature at every
patient visit. The information was attached to the
medical chart as BMI =. Physicians in the
control group continued to have only standard vital
signs listed in their charts of each patient visit,
without a listing of the BMI. For the control group
physicians, the BMI was calculated separately
without knowledge of the physician so that the
presence of obesity, documented or not, could be
ascertained.

Data Collection: Physician documentation of
patient obesity was assessed by chart review after
patient visits. Documentation was defined as
inclusion of obesity on the problem list or in the
progress note. Thirty medical charts from each
resident physician (a total of 420 charts) were
reviewed by a research assistant prior to the
intervention. Due to physician attrition (graduation
from residency), an average of 19 medical charts per
physician (a total of 268) were available for review
following the intervention. For each physician, a
proportion was calculated of times he/she correctly
documented obesity when the patient was in fact
obese. The BMI was calculated for all patients.
“Overweight” was defined as a BMI of 25 to 28 for
women and 26 to 29 for men, while “Obesity” was
20 percent or more above the desired weight, that is
> 29 for women and > 30 for men.²

Data Analysis: Descriptive statistics were used
to describe the BMI characteristics of patients. The
t-test was calculated to determine whether a
difference existed in the documentation rates of
physicians the experimental and control groups
following the intervention.

Results

The documentation of obesity is shown in Table
1. Prior to the intervention, there were no statistically
significant differences in documentation rate between
physicians in the experimental group (24.1%) and
those in the control group (29.5%), t (df = 6)= -.500,
p= .626). Similarly, following the intervention, the

Table 1

Summary of BMI Data

*Obesity defined as >20% overweight (BMI >29 for women, >30 for men)

**Of the 7 physicians in each group, the mean percentage of times obesity was documented when the
patient actually met the criterion of obesity

<<   <   1   2   3   4   >   >>