Abstract
Objective
To determine whether parental reports and electronic health record documentation of
physician counseling on nutrition and physical activity reflect actual counseling
provided.
Methods
Participants were parents of 198 children 2 to 12 years of age seen in a primary care
pediatric clinic at an academic medical center for well child care and their 38 physicians.
Parents completed a post-visit questionnaire to report discussions on weight, nutrition,
and physical activity that occurred during the visit. Electronic health records were
reviewed to measure documentation of these topics during the visit. Parental reports
and records were compared with actual discussions on the basis of coded audiotapes.
Counseling was coded as having occurred if specific topics were mentioned during the
encounter, however brief this mention was.
Results
A total of 48% of the children were female, they were a mean age of 5.4 years, and
28% were overweight or obese. Sensitivity of parental report was high (63%–96%), but
specificity was low (43%–77%) because of parents’ tendency to overreport counseling.
Sensitivity of electronic health record documentation was generally low (40%–53%)
except for discussion of screen time (92%) and physical activity (88%); the specificity
of these data was also poor (42% and 21%, respectively, for screen time and physical
activity).
Conclusions
Electronic health record documentation may not be the most valid method of measuring
physician counseling on weight, nutrition, and physical activity in pediatric primary
care. Parental report via the use of a questionnaire administered immediately after
the visit is a better alternative in quality improvement or research studies when
resources do not allow for direct observation, with the caveat that parents may overreport
whether counseling was provided.
Keywords
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Article info
Publication history
Published online: January 03, 2012
Accepted:
October 25,
2011
Received:
August 27,
2011
Footnotes
The authors have no conflicts of interest to disclose.
Identification
Copyright
© 2012 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
