Exercise as a Vital Sign in the Pediatric Well Child Visit

Purpose/Objectives: Pediatric physical activity is a key aspect of overall health and wellness. The rise in pediatric obesity has led to a 4.8% increase in the incidence of Type 2 diabetes in the last decade. The AAP reports that only 26.1% of adolescents are meeting activity guidelines. In addition, the AAP found that after the 2008 American Physical Activity guidelines were released, only 33.3% of pediatricians could identify the current guidelines.1 The purpose of this quality improvement project was to increase pediatric resident assessment and documentation of weekly physical activity at well child exams for patients aged 18m-18years from the initial rate (15.6%) to a goal of 50% within one year.

Design/Methods: Three PDSA cycles, each lasting 2 months, were completed, each utilizing a new intervention to attempt to increase the documentation rate of exercise in pediatric patients 18months and older at well visits within the resident clinic. Cycle 1 utilized a printout of the US Department of Health's recommendations for age specific moderate physical activity. It included questions of duration and frequency and of each child’s participation in moderate physical activity. MAs (medical assistants) completed the form, and the printout was given to the resident for documentation in the EMR. Cycle 2 utilized this same document, but instead of being provided to the resident, the MAs entered the responses directly into the EMR. Cycle 2 also measured exercise counseling as an assessment during the patient encounter. Pediatric residents were educated on the need for assessing exercise counseling. Cycle 3 built off the previous two cycles utilizing a physical activity guideline handout that residents provided to and discussed with families during the well child visit. Documentation rates were monitored in each cycle, and assessment rates were monitored in Cycles 2 and 3 by EMR chart review for well child checks 18 months and older.

Results: The initial documentation rate of physical activity was 15.6%. At the end of Cycle 1, the documentation rates by pediatric residents increased to 54%, surpassing the one-year goal within the first two-month period. Cycle 2 demonstrated a continued increase in documentation rates, increasing to 68.5% and the assessment rate for exercise counseling increased from 0% to 28.8%. Finally, Cycle 3 saw an increase in documentation rates to 75.2% and assessment rate of 32.4%. Overall, the documentation rate increased to almost 5 times the initial rate.

Conclusion/Discussion: Quantifying physical activity and providing exercise counseling to families during well child visits in our resident clinic significantly increased documentation and assessment rates of weekly physical activity for 18mo – 18yo well child exams.