Documentation of body mass index and control of associated risk factors in a large primary care networkReport as inadecuate

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BMC Health Services Research

, 9:236

First Online: 16 December 2009Received: 17 May 2009Accepted: 16 December 2009DOI: 10.1186-1472-6963-9-236

Cite this article as: Rose, S.A., Turchin, A., Grant, R.W. et al. BMC Health Serv Res 2009 9: 236. doi:10.1186-1472-6963-9-236


BackgroundBody mass index BMI will be a reportable health measure in the United States US through implementation of Healthcare Effectiveness Data and Information Set HEDIS guidelines. We evaluated current documentation of BMI, and documentation and control of associated risk factors by BMI category, based on electronic health records from a 12-clinic primary care network.

MethodsWe conducted a cross-sectional analysis of 79,947 active network patients greater than 18 years of age seen between 7-05 - 12-06. We defined BMI category as normal weight NW, 18-24.9 kg-m, overweight OW, 25-29.9, and obese OB, ≥ 30. We measured documentation yes-no and control above-below of the following three risk factors: blood pressure BP ≤130-≤85 mmHg, low-density lipoprotein LDL ≤130 mg-dL 3.367 mmol-L, and fasting glucose <100 mg-dL 5.55 mmol-L or casual glucose <200 mg-dL 11.1 mmol-L.

ResultsBMI was documented in 48,376 patients 61%, range 34-94%, distributed as 30% OB, 34% OW, and 36% NW. Documentation of all three risk factors was higher in obesity OB = 58%, OW = 54%, NW = 41%, p for trend <0.0001, but control of all three was lower OB = 44%, OW = 49%, NW = 62%, p = 0.0001. The presence of cardiovascular disease CVD or diabetes modified some associations with obesity, and OB patients with CVD or diabetes had low rates of control of all three risk factors CVD: OB = 49%, OW = 50%, NW = 56%; diabetes: OB = 42%, OW = 47%, NW = 48%, p < 0.0001 for adiposity-CVD or diabetes interaction.

ConclusionsIn a large primary care network BMI documentation has been incomplete and for patients with BMI measured, risk factor control has been poorer in obese patients compared with NW, even in those with obesity and CVD or diabetes. Better knowledge of BMI could provide an opportunity for improved quality in obesity care.

AbbreviationsATP IIIAdult Treatment Panel III

BPBlood Pressure

BMIBody Mass Index

CVDCardiovascular disease

CDCCenters for Disease Control

EHRElectronic Health Record

HEDISHealthcare Effectiveness Data and Information Set

ICD-9International Classification of Diseases, Ninth Revision

LDLLow-density Lipoprotein

MGHMassachusetts General Hospital

NCQANational Committee for Quality Assurance

NHLBINational Heart, Lung, and Blood Institute

NIDDKNational Institute of Diabetes and Digestive and Kidney Diseases

NWNormal weight



PBRNPractice-Based Research Network

PCPPrimary Care Physician

RPDRResearch Patient Data Repository

USUnited States.

Electronic supplementary materialThe online version of this article doi:10.1186-1472-6963-9-236 contains supplementary material, which is available to authorized users.

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Author: Stephanie A Rose - Alexander Turchin - Richard W Grant - James B Meigs



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