Inpatient Obesity Recognition and Diagnosis in Pediatric Patients.

BACKGROUND AND OBJECTIVES: Despite obesity's effect on pediatric patient health, the role of hospitalizations in recognizing and diagnosing pediatric obesity is poorly explored. METHODS: We performed a retrospective cohort study of pediatric inpatients aged 2 to 18 years utilizing CERNER Health Facts database to determine the: (1) prevalence of obesity in a large, multicenter inpatient database, (2) appropriate International Classification of Diseases, 10th Revision, obesity diagnosis proportion, and (3) variables associated with appropriate obesity diagnosis. Covariates included patient demographics and hospital descriptors, which were summarized using frequencies, and differences across groups were compared using χ Square testing. RESULTS: Of the hospitalized children with obesity (19.5%), only 13.2% had an appropriate obesity diagnosis. Appropriate obesity diagnosis increased with higher obesity class and was least common in the South census region at only 8.5%. CONCLUSIONS: Despite pediatric hospitalizations being a potential area for recognition and intervention of obesity, the majority of hospitalized children do not receive an appropriate obesity diagnosis.

Improving Sexually Transmitted Infection Screening in Inpatient Pediatric Patients.

BACKGROUND: Sexually transmitted infections (STIs) are a group of infectious diseases that cause acute illness and lifelong health effects. Half of the diagnosed cases occur in adolescents and young adults, ages 15 to 24. The American Academy of Pediatrics and the Centers for Disease Control and Prevention provide guidelines for STI screening for sexually active adolescents. Despite this, screening rates in adolescents admitted to our hospital are low. The purpose of this study is to use quality improvement methodology to improve the percent of adolescent patients who had documentation of sexual histories from 49% to 69% and STI testing from 29% to 49%. METHODS: Eligible patients included adolescents ages 14 to 18 admitted to our hospital's academic general pediatric service. After baseline data collection, we introduced a series of 6 interventions; percentages of sexual history documentation and STI screening were recorded monthly. Interventions included resident education on STI screening, history, and physical form prompts for sexual history documentation, "badge buddy" sexual history templates, faculty development, and an electronic medical record template. Data were interpreted by using statistical process control to show process change. RESULTS: Before the interventions, 48.7% of patients ages 14 to 18 had sexual histories documented; 29.1% of patients were tested for STIs. After interventions, there was a special cause variation resulting in new center lines of 67.1% and 49.1%, respectively. CONCLUSIONS: Simple interventions to normalize and standardize adolescent sexual history discussions cumulatively led to a significant increase in sexual history documentation and STI screening in an inpatient adolescent population.