RESUMO
This article describes the implementation of an enhanced electronic medical record (EMR) system in three community health care centers in the Greater New Orleans area of Louisiana. This report may aid efforts directed at the implementation of enriched tools, such as decision support, in an EMR with the goal of improving pediatric asthma outcomes.
Assuntos
Asma/terapia , Registros Eletrônicos de Saúde/organização & administração , Fidelidade a Diretrizes , Pediatria/normas , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Criança , Pré-Escolar , Centros Comunitários de Saúde , Humanos , Nova Orleans , Projetos Piloto , Guias de Prática Clínica como AssuntoRESUMO
PURPOSE: Identify risk factors for obesity across the lifespan for individuals with spina bifida. METHODS: Cross sectional chart review study of 203 patients aged 6-58 years. Obesity was based on body mass index. Rates were calculated for children aged 6-11 years; adolescents aged 12-19 years and adults aged > 20 years. Chi-square analyses were used to determine differences in obesity rates among subgroups. An ordered logistic regression model was developed for the three age groups to estimate the probability of a change in BMI classification from normal weight to overweight or overweight to obese, controlling for sex, functional motor level, shunt status and insurance status. RESULTS: Obesity rates for children, adolescents and adults were 18, 8 and 37%, respectively. Obesity rates were higher among adults (chi2 = 27, p < 0.01) and for individuals who were publicly insured (chi2 = 7.2, p < 0.03). The ordered regression model for children demonstrated no independent association between sex, shunt status, functional motor level or insurance status and change in BMI category. For adolescents, lower functional motor level (i.e. sacral) increased the risk of becoming obese (Odds Ratio: 2.13; 95% CI: 1.12-4.06; p < 0.02). Among adults, female sex increased risk (OR = 2.28; 95% CI: 1.03-5.04; p < 0.04). CONCLUSIONS: Obesity rates for children and adolescents with spina bifida are similar to the general population; however, obesity rates are higher among adults, particularly women. Risk factors are similar to those observed in the general population.
