O0005: The Eating Disorder Smartset: Improving Identification and Treatment of Children and Adolescents with Eating Disorders

Purpose/Objectives: An increasing number of children and adolescents are affected by eating disorders. The most common eating disorder is binge eating disorder which is prevalent among children and adolescents with obesity. The American Academy of Pediatrics (AAP) advises general pediatricians to systematically identify and treat eating disorders. However, many pediatricians do not feel well equipped to do so and often struggle to identify community nutrition and mental health providers to refer patients with eating disorders. The aim of this MOC-4 approved quality improvement project is to improve the primary care identification and management of eating disorders by developing a Smartset into the Epic Electronic Health Record to help guide pediatricians in providing the highest quality of care in the recognition, evaluation, and treatment of eating disorders.

Design/Methods: A smart set was developed and implemented in the Epic electronic health record at Children’s Primary Care Medical Group (CPCMG), a 28-site single-specialty pediatrics practice in San Diego and Riverside Counties, based on DSM 5 criteria for the diagnosis of eating disorders, the AAP recommendations for the identification and management of eating disorders, local recommendations for laboratory evaluation and consideration of medical risk from inpatient, intensive outpatient, and partial hospitalization programs, and local supports and resources for nutrition and behavioral health referrals and resources. The Smartset includes signs and symptoms of eating disorder, recommended physical exam and lab evaluation, the EAT 26 screening patient-answered questionnaire, local referral sources, primary care based supports to follow up with patients, and patient education materials.

All CPCMG pediatricians received a 1-hour training on the algorithm and smart-set and pediatricians participating in the MOC-4 quality improvement project also participated in a follow-up feedback session and further training from a local eating disorder expert, used the smart set at least 10 times, and reviewed data of the eating disorder smartset utilization monthly.

Results: In the first 6 months of the MOC-4 quality improvement project, 95 pediatricians at 25 sites used the Epic-based eating disorder smartset. Of those, 17 used the smartset more than 10 times and completed the requirements to receive 25 points of MOC 4 credit. All of the 20 providers who completed the quality improvement survey reported increased confidence in the identification and treatment of eating disorders and qualitative feedback included that the smartset and educational sessions were very helpful.

Conclusion/Discussion: Integrating an eating disorder smartset into the electronic medical record helped to improve pediatrician confidence and competence in the identification and management of eating disorders in the primary care setting.