• Poster
  • October 1, 2013

POWER—Developing a Multi-site Pediatric Obesity Management Registry (#3)

Shelley Kirk, PhD, RD, LD, Associate Professor, University of Cincinnati Department of Pediatrics; Director, HealthWorks!
Eileen King, PhDAssociate Professor, Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
Brooke Sweeney, MD, FAPP, Assistant Professor; Medical Director, Healthy for Life!, Kosair Children's Hospital, Louisville, KY

Carolyn Jasik, MD, Assistant Professor, University of California, San Francisco, CA

Learning Objectives:
  • Understand the severity of disease in patients presenting for weight management
  • Determine the factors associated with engagement in these programs
  • Document the clinical response as measured by change in weight status and lab values

Introduction/Background:
The POWER project grew out of the "Focus on a Fitter Future" (FFF) initiative hosted by the Children’s Hospital Association (CHA). The goal of this group is to bring weight management programs from children’s hospitals together to support collaboration around research, quality improvement and patient care.

Initiative Description:
To address the gap in evidence on the characteristics and success of multi-disciplinary weight management programs, the Pediatric Obesity Weight Evaluation Registry (POWER)  was formed through the Children’s Hospital Association "Focus on a Fitter Future"  initiative during 2010-2013.  It is a collaborative of 13 children’s hospital weight management programs.  Each site contributed retrospective patient data to form a registry of 7040 patients seen from 2009-2010 in their multi-disciplinary weight management programs. This poster presents the data for Learning Objective 1 which is to understand the severity of disease in patients presenting for weight management.

Innovation:
Despite pediatric obesity being the most prevalent childhood chronic disease, there are no national data on patient characteristics of those presenting for pediatric weight management and how obese children respond to weight management as recommended by national guidelines.  The POWER registry was formed to address this gap in knowledge.

Results/Outcomes or Potential Results/Outcomes:
The current data set includes 7040 patients from 13 sites.  These baseline data show 35% of patients are obese [body mass index (BMI) > 95th and < 99th percentile], while 61.4% of patients are severely obese (BMI > 99th percentile). Since national guidelines recommend referral at the 95th percentile, a disproportionate number of severely obese youth are receiving weight management services later than advised. Patients, age 2 to 5 years, represent only 6.5% of referred patients and yet 92% are already severely obese at presentation, compared to approximately 60% in each of the other age categories (6-11y, 12-14y, 15-17y, 18-20y). In addition there are significantly more males (68%) than females (56%) who are severely obese. Also there is a greater percentage of African-American patients (68%) who are severely obese in comparison to Caucasian patients (56%).  For privately insured patients, there is a lower percentage who are severely obese (56%) compared to those patients with Medicaid (66%).  Baseline laboratory data was available from approximately a third of the patient database. Of concern is that 29% of these patients (n=1785) have an abnormal hemoglobin A1C (>5.7%) and 45% of patients (n=2219) have abnormal fasting insulin (>20 mg/dl).

Lessons Learned:
It is possible to combine patient data from multiple clinical sites for quality improvement initiatives and to facilitate collaborative research.   These data will allow us to inform our practice both in terms of facilitating earlier referrals and outreach to groups with reduced access.  Most importantly, we learned the importance of having the support and infrastructure of the Children's Hospital Association to facilitate our efforts.  Our challenge going forward with the prospective POWER project is to secure long-term funding to support the on-going infrastructure, including data management, as well as quality improvement and research activities.

Future of Initiative/Next Steps:
Further data analysis is underway to describe program engagement of patients with Stage 3 multidisciplinary weight management clinics and outcomes on changes in weight status and associated comorbidities.  The retrospective POWER study will guide the development of the prospective POWER  project to aid in further efforts to improve clinical services offered and achieve improved outcomes for weight status and associated comorbidities in patients presenting to tertiary care centers for pediatric weight management and obesity chronic disease management.