196 - Improving Cardiovascular Risk Factor Screening in an Outpatient Pediatric Cardiology Clinic

Poster Number: 196
Publication Number: 196.143

Rachel J. Shustak, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Justin H. Berger, The Children's Hospital of Philadelphia, Philadelphia, PA, United States; Robert Olsen, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Aaron T. Dorfman, Childrens Hospital of Philadelphia, Voorhees, NJ, United States; Julie A. Brothers, Perelman School of Medicine at the University of Pennsylvania, Philadephia, PA, United States; Shobha Natarajan, The Children's Hospital of Philadelphia, Philadelphia, PA, United States

Background: Children with congenital and acquired heart disease are overweight and obese at rates comparable to the general population. These children can have structural or functional abnormalities that make them more vulnerable to the development of early atherosclerosis. Obesity is one of the few modifiable risk factors for preventing future cardiovascular disease, however, targeted screening and counseling are rare in the outpatient pediatric cardiology clinic.

Objective: To assess the effectiveness of an electronic medical record Best Practice Advisory (BPA) aimed at increasing overweight- and obesity-related counseling, lipid testing, and referrals in an academic pediatric cardiology clinic.

Design/Methods: The BPA was introduced in the outpatient pediatric cardiology clinic at the Children’s Hospital of Philadelphia in February 2021. The BPA was triggered when both height and weight were entered and body mass index (BMI) was ≥85th%ile. The BPA was designed to facilitate one-click ordering of lipid panel and referrals and simplify documentation and counseling (Figure 1). We compared the prevalence of lipid panel ordering and BMI directed referrals before (2/1/2020-1/31/2021) and after the intervention (2/1/2021-9/30/2021). Statistical process control charts were used to evaluate the data over time.

Results: A total of 10,980 patients were seen during the study period (5677 pre- and 5303 post-intervention). The prevalence of overweight and obesity in the cohort was 33% and 18%, respectively; 35% of patients had a BPA-derived action. Introduction of the BPA resulted in a shift in the mean for both ordering of lipid testing and referrals (Figures 2). The increase was most pronounced in those with a BMI ≥99th%ile with an increase of 14% and 15% in lipid testing and referrals, respectively (Figure 3).Conclusion(s): An electronic medical record BPA can increase BMI directed actions in an outpatient cardiology clinic. The largest impact was seen in those with the most severe obesity (BMI >99th%ile). Future work will evaluate the impact of the BPA on documentation of counseling and investigate potential sociodemographic disparities in order placement and referral patterns.
Cardiovascular risk factor screening Best Practice Advisory (BPA) for the outpatient pediatric cardiology clinicThe BPA facilitates one-click ordering of lipid panel and referrals, simplifies documentation and counseling, and provides easy access to educational handouts.
Statistical process control charts for those with BMI ≥ 85%ile Statistical process control charts demonstrating the change in ordering of lipid testing and referrals over time. In patients with BMI ≥ 85th%ile, the BPA was associated with a 6.6% increase in lipid testing and 4% increase in referrals resulting in a mean shift.