Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, 9th floor, Chicago, IL 60611, USA.
J Gen Intern Med. 2012 Aug;27(8):933-9. doi: 10.1007/s11606-012-2022-8. Epub 2012 Mar 9.
Physicians often do not recognize when their patients are overweight and infrequently counsel them about weight loss.
To evaluate a set of electronic health record (EHR)-embedded tools to assist with identification and counseling of overweight patients.
Randomized controlled trial.
Physicians at an academic general internal medicine clinic were randomized to activation of the EHR tools (n = 15) or to usual care (n = 15). Patients of these physicians were included in analyses if they had a body mass index (BMI) between 27 and 29.9 kg/m(2).
The EHR tool set included: a physician point-of-care alert for overweight (BMI 27-29. 9 kg/m(2)); a counseling template to help physicians counsel patients on action plans; and an order set to facilitate entry of overweight as a diagnosis and to order relevant patient handouts.
Physician documentation of overweight as a problem; documentation of weight-specific counseling; physician perceptions of the EHR tools; patient self-reported progress toward their goals and perspectives about counseling received.
Patients of physicians receiving the intervention were more likely than those of usual care physicians to receive a diagnosis of overweight (22% vs. 7%; p = 0.02) and weight-specific counseling (27% vs. 15%; p = 0.02). Most patients receiving counseling in the intervention group reported increased motivation to lose weight (90%) and taking steps toward their goal (93%). Most intervention physicians agreed that the tool alerted them to patients they did not realize were overweight (91%) and improved the effectiveness of their counseling (82%); more than half (55%) reported counseling overweight patients more frequently (55%). However, most physicians used the tool infrequently because of time barriers.
EHR-based alerts and management tools increased documentation of overweight and counseling frequency; the majority of patients for whom the tools were used reported short-term behavior change.
医生通常无法识别其超重患者，且很少对其进行减肥建议。
评估一套电子健康记录（EHR）嵌入式工具，以帮助识别和为超重患者提供建议。
随机对照试验。
学术性普通内科诊所的医生被随机分为 EHR 工具激活组（n=15）或常规护理组（n=15）。只有当这些医生的患者 BMI 处于 27 至 29.9kg/m² 之间时，其患者才被纳入分析。
EHR 工具集包括：超重医生即时护理提醒（BMI 27-29.9kg/m²）；帮助医生制定行动计划以对患者进行建议的模板；以及方便超重作为诊断并开处相关患者手册的医嘱集。
医生将超重作为问题记录的情况；对体重相关建议的记录情况；医生对 EHR 工具的看法；患者对其目标的进展自我报告和对所接受建议的看法。
接受干预的医生的患者比接受常规护理的医生的患者更有可能被诊断为超重（22%比 7%；p=0.02）和接受体重相关建议（27%比 15%；p=0.02）。在干预组中接受建议的大多数患者报告称减肥动力增强（90%），并朝着目标采取了措施（93%）。大多数干预医生认为该工具提醒他们注意到之前没有意识到超重的患者（91%），并提高了他们的建议效果（82%）；超过一半（55%）的医生报告称更频繁地为超重患者提供建议（55%）。但是，由于时间障碍，大多数医生很少使用该工具。
基于 EHR 的提醒和管理工具增加了超重和建议频率的记录；大多数使用该工具的患者报告称短期内有行为改变。
