Recording of weight in electronic health records: an observational study in general practice

Abstract

BackgroundRoutine weight recording in electronic health records (EHRs) could assist general practitioners (GPs) in the identification, prevention, and management of overweight patients. However, the extent to which weight management is embedded in general practice in the Netherlands has not been investigated. The purpose of this study was to evaluate the frequency of weight recording in general practice in the Netherlands for patients who self-reported as being overweight. The specific objectives of this study were to assess whether weight recording varied according to patient characteristics, and to determine the frequency of weight recording over time for patients with and without a chronic condition related to being overweight.MethodsBaseline data from the Occupational and Environmental Health Cohort Study (2012) were combined with data from EHRs of general practices (2012–2015). Data concerned 3446 self-reported overweight patients who visited their GP in 2012, and 1516 patients who visited their GP every year between 2012 and 2015. Logistic multilevel regression analyses were performed to identify associations between patient characteristics and weight recording.ResultsIn 2012, weight was recorded in the EHRs of a quarter of patients who self-reported as being overweight. Greater age, lower education level, higher self-reported body mass index, and the presence of diabetes mellitus, chronic obstructive pulmonary disease, and/or cardiovascular disorders were associated with higher rates of weight recording. The strongest association was found for diabetes mellitus (adjusted OR = 10.3; 95% CI [7.3, 14.5]). Between 2012 and 2015, 90% of patients with diabetes mellitus had at least one weight measurement recorded in their EHR. In the group of patients without a chronic condition related to being overweight, this percentage was 33%.ConclusionsWeight was frequently recorded for overweight patients with a chronic condition, for whom regular weight measurement is recommended in clinical guidelines, and for which weight recording is a performance indicator as part of the payment system. For younger patients and those without a chronic condition related to being overweight, weight was less frequently recorded. For these patients, routine recording of weight in EHRs deserves more attention, with the aim to support early recognition and treatment of overweight.Electronic supplementary materialThe online version of this article (10.1186/s12875-018-0863-x) contains supplementary material, which is available to authorized users.

Determinants and extent of weight recording in UK primary care: an analysis of 5 million adults’ electronic health records from 2000 to 2017

“…Our results support the hypothesis that weight recording is more frequent when incentivised but declines when the incentives are removed. The same close link between incentivisation and weight recording has been described in Holland, where it is incentivised in chronic conditions [9]. Others have previously noted increased weight recording in the early years of the UK QOF [8, 15].…”

“…For example, in one study in 2015, 97% of people with diabetes had a weight recording but only 54% of people without diabetes [29]. Other studies have reported that weight recording was more common in young adults [30], older age adults [9, 27], female sex [27, 30], higher BMI [9, 27], high deprivation [27, 30], a diagnosis of diabetes [9, 29, 30], COPD [9], cardiovascular disease [9, 30] and stroke [30]. In addition, we have shown associations with low BMI and increasing comorbidity.…”

“…In some countries, weight measurement occurs infrequently in clinical practice [7], resulting in the underestimation of obesity in the UK’s primary care electronic health record (EHR) compared to national health survey data [8]. Only one quarter of Dutch patients who self-reported being overweight had a body mass index (BMI) recorded in their EHR [9].…”

<p>The internal validation of weight and weight change coding using weight measurement data within the UK primary care Electronic Health Record</p>

“…Although weight is a simple low-cost biometric retained in multiple clinical prediction models,4–7 weight measurements are commonly missing (not at random) from Electronic Health Records (EHRs) in primary care 8,9. In clinical settings where weight is not measured routinely, it is most commonly measured in relation to the clinical problem, chronic disease, or in patients who appear overweight or underweight 10,11. When measured, kilograms (kg), pounds, and body mass index (BMI) may be recorded inconsistently in structured or free text 12,13.…”

Unsystematic Tracking of BMI Through Electronic Medical Records Hinders Weight Management Over the Life Course

“…Previous studies have suggested that BMI is more likely to be recorded for individuals who have overweight or obesity (5), and patients with documented overweight or obesity are more likely to receive weight management support (6). Early recognition and treatment of overweight are critical, as few evidence-based practices for long-term adult weight loss exist (7). Missing BMI presents a missed opportunity for integrating obesity prevention into wellness visits.…”