Implementing a novel electronic health record approach to track child sugar-sweetened beverage consumption

Abstract

Sugar-sweetened beverage (SSB) consumption is a risk factor for childhood obesity. Including this measure in electronic health records (EHR) could enhance clinical care and facilitate research on this topic. We implemented a single-item, EHR screening question for SSB and 100% fruit juice at 8 pediatric practices affiliated with a North Carolina academic medical center. From March–December 2017, we evaluated SSB screening of children 6 months–17 years of age. In a sub-sample of screened patients, we also conducted a telephone-based validation survey, comparing EHR-based responses to a lengthier beverage questionnaire, using Spearman rank coefficients and Kappa statistic. 22,626 children (91% of all seen) were screened for SSB intake. The screened population was diverse – 35% non-Hispanic White, 26% African-American, and 30% Hispanic. Consistent with national estimates, reported intake was typically higher than recommended: 41% (n = 9220) reported consuming SSB or fruit juice >1×/day in the past month, and consumption was higher among race/ethnic minorities. Of 201 validation survey respondents, direct correlation between their beverage survey and EHR screener responses was moderate, with a Spearman's rank correlation coefficient of 0.41 (p < 0.001) and Kappa statistic of 0.42 (95% CI 0.24–0.60). EHR-based screening for SSBs and fruit juice was successfully implemented, generating a large volume of SSB consumption data in a diverse patient population. Inclusion of patient-reported dietary measures in the EHR is feasible and could be useful for clinical care and research. Planned modifications may improve the correlation of such a screener with lengthier dietary instruments.

Identifying geographic differences in children's sugar‐sweetened beverage and 100% fruit juice intake using health system data

“…To increase routine and standardized screening of children for SSB and fruit juice intake in our health system, we created and implemented a point‐of‐care EHR‐based SSB and fruit juice consumption screener in eight paediatric primary care clinics in March of 2017 28 . Participating clinics provide care for a diverse patient population of over 20 000 children annually in urban, suburban and rural settings.…”

“…We used data from an electronic health record (EHR) SSB and 100% fruit juice screening program in eight paediatric primary care clinics to examine consumption patterns by geography 28 . The primary objective of this study was to demonstrate the feasibility of using health system data to examine the geographic distribution of children's SSB and 100% fruit juice intake in a large, diverse area.…”

Use of Electronic Health Record Data to Study the Association of Sugary Drink Consumption With Child Weight Status

“…In the Spring of 2017, we implemented a pointof-care electronic health record (EHR)-based screening question for child SSBs and 100% fruit juice (abbreviated subsequently as "sugary drinks") consumption at a large academic medical center in North Carolina. 16 The aim of the screener was to facilitate the routine capture of sugary drink consumption information for children of all ages.…”

“…Respondents chose a single option from an ordinal categorical list of consumption frequencies ranging from "Never" to "4 or more per day." 16 Because of the time constraints of clinical practice and evidence linking juice consumption with greater SSB intake and adiposity, the screening question grouped SSBs and fruit juice consumption together. 17,18 The question was validated against NHANES measures (data previously published).…”

“…17,18 The question was validated against NHANES measures (data previously published). 16 We used screener data abstracted from the EHR to characterize child sugary drink consumption into the following frequency categories: "Less than once per week," "Several per week but not every day," "1 per day," "2 per day," and "3 or more per day. "…”