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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Academic PediatricsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Prevalence of high body mass index in US children and adolescents, 2007–2008.JAMA. 2010; 303: 242-249
- Risks and consequences of childhood and adolescent obesity.Int J Obes Relat Metab Disord. 1999; 23: S2-S11
- Preventing Childhood Obesity - Health in the Balance.U.S. Institute of Medicine, Washington, DC2005
- Factors related to adiposity among children aged 3 to 7 years.J Am Diet Assoc. 1999; 99: 938-943
- Childhood obesity’s relationship to time spent in sedentary behavior.Mil Med. 2003; 168: 583-586
- Quality of health care for children: role of health and chronic illness in inpatient care experiences.Arch Pediatr Adolesc Med. 2007; 161: 828-834
- Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: summary report.Pediatrics. 2007; 120: S164-S192
- HEDIS 2011 Summary Table of Measures: Weight Assessment and Counseling for Nutritionand Physical Activity for Children/Adolescents.(Available at:) (Accessed May 31, 2011)
Centers for Medicare and Medicaid Services. EHR Incentive Program Electronic. Available at: Specifications. 2011; https://www.cms.gov/QualityMeasures/03_ElectronicSpecifications.asp. Accessed June 1, 2011.
- Adoption of body mass index guidelines for screening and counseling in pediatric practice.Pediatrics. 2010; 125: 265-272
- Underdiagnosis of pediatric obesity during outpatient preventive care visits.Acad Pediatr. 2010; 10: 405-409
- Assessment of body mass index and association with adolescent preventive care in U.S. outpatient settings.J Adolesc Health. 2009; 44: 502-504
- Trends in the diagnosis of overweight and obesity in children and adolescents: 1999–2007.Pediatrics. 2009; 123: e153-e158
- Pediatricians’ and family physicians’ weight-related care of children in the U.S.Am J Prev Med. 2011; 41: 24-32
- Obesity prevention, screening, and treatment: practices of pediatric providers since the 2007 expert committee recommendations.Clin Pediatr. 2011; 50: 434-441
- Bridging the quality chasm for children: need for valid, comprehensive measurement tools.Arch Pediatr Adolesc Med. 2007; 161: 909-910
- TIMER: A new objective measure of consultation content and its application to computer assisted consultations.BMJ. 1986; 293: 20-22
- Validity of maternal report of acute health care use for children younger than 3 years.Arch Pediatr Adolesc Med. 2005; 159: 167-172
- Validity of parental report of a child’s medical history in otitis media research.Am J Epidemiol. 1994; 139: 1116-1121
- Adequacy of medical chart review to characterize emergency care for asthma: findings from the Illinois Emergency Department Asthma Collaborative.Acad Emerg Med. 2006; 13: 345-348
- Pediatric asthma care in the emergency department: measuring the quality of history-taking and discharge planning.J Asthma. 1999; 36: 129-138
- How valid are medical records and patient questionnaires for physician profiling and health services research? A comparison with direct observation of patients visits.Med Care. 1998; 36: 851-867
- Child Health Care Quality Toolbox: Established Child Health Care Quality Measures- Child and Adolescent Health Measurement Initiative: Promoting Healthy Development Survey.(Available at:) (Accessed November 18, 2011)
- The patient exit interview as an assessment of physician-delivered smoking intervention: a validation study.Health Psychol. 1999; 18: 183-188
- About BMI for Children and Teens.(Available at:) (Accessed Oct 21, 2011)
- SAS 9.2.([computer program]) SAS Institute, Cary, NC2008
- Confidence intervals for clustered samples.American Sociological Review. 1957; 22: 154-165
- Comparison of patient questionnaire, medical record, and audio tape in assessment of health promotion in general practice consultations.BMJ. 1994; 309: 1483
- Accuracy of recall of exercise counseling among primary care patients.Prev Med. 2004; 39: 1063-1067
- Opportunistic health promotion quantity or quality?.J R Coll Gen Pract. 1989; 39: 196-200
- Correspondence among patients’ self-report, chart records, and audio/videotapes of medical visits.Health Communication. 2003; 15: 393-413
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.