Translational Behavioral Medicine

, Volume 7, Issue 4, pp 881–890 | Cite as

Effect of an obesity best practice alert on physician documentation and referral practices

  • Stephanie L. Fitzpatrick
  • Kirsten Dickins
  • Elizabeth Avery
  • Jennifer Ventrelle
  • Aaron Shultz
  • Ekta Kishen
  • Steven Rothschild
Original Research


The Centers for Medicare & Medicaid Services Electronic Health Record Meaningful Use Incentive Program requires physicians to document body mass index (BMI) and a follow-up treatment plan for adult patients with BMI ≥ 25. To examine the effect of a best practice alert on physician documentation of obesity-related care and referrals to weight management treatment, in a cluster-randomized design, 14 primary care clinics at an academic medical center were randomized to best practice alert intervention (n = 7) or comparator (n = 7). The alert was triggered when both height and weight were entered and BMI was ≥30. Both intervention and comparator clinics could document meaningful use by selecting a nutrition education handout within the alert. Intervention clinics could also select a referral option from the list of clinic and community-based weight management programs embedded in the alert. Main outcomes were proportion of eligible patients with (1) obesity-related documentation and (2) referral. There were 26,471 total primary care encounters with 12,981 unique adult patients with BMI ≥ 30 during the 6-month study period. Documentation doubled (17 to 33%) with implementation of the alert. However, intervention clinics were not significantly more likely to refer patients to weight management than comparator clinics (2.8 vs. 1.3%, p = 0.07). Although the alert was associated with increased physician meaningful use compliance, it was not an effective strategy for improving patient access to weight management services. Further research is needed to understand system-level characteristics that influence obesity management in primary care.


Obesity Best practice alert Primary care Electronic health record 



We would like to acknowledge Anthony Perry, MD, Bala Hota, MD, Jayson Woods, and Tamara Olinger, MS, for their contributions to the best practice alert design as well as the data extraction and coordination plans.

Compliance with ethical standards


This study was funded by internal support from Rush University Medical Center.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the Rush University Medical Center IRB and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study did not include animals.

Informed consent

For this type of study, formal consent from patients was waived by the IRB.

The findings reported have not been previously published, and the manuscript is not being simultaneously submitted elsewhere.

Authors had full control of all primary data, and they agree to allow the journal to review their data if requested.


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Copyright information

© Society of Behavioral Medicine 2017

Authors and Affiliations

  • Stephanie L. Fitzpatrick
    • 1
    • 2
  • Kirsten Dickins
    • 1
  • Elizabeth Avery
    • 1
  • Jennifer Ventrelle
    • 1
  • Aaron Shultz
    • 1
  • Ekta Kishen
    • 1
  • Steven Rothschild
    • 1
  1. 1.Rush University Medical CenterChicagoUSA
  2. 2.Center for Health ResearchKaiser Permanente NorthwestPortlandUSA

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