O1029: Measures that Matter: Engaging Community Health Centers in the Development of Meaningful Weight Management Quality Measures

Purpose/Objectives: The prevalence of unhealthy weight among children has increased over decades, including in patients seen at Community Health Centers (CHCs). These patients face systemic and structural inequities and additional barriers to maintaining healthy weight. CHCs play a crucial role in addressing disparities through prevention and management of obesity and comorbidities. There is consensus among clinicians that the current clinical quality measure (CQM) on weight assessment and counseling for nutrition and physical activity does not capture efforts to address obesity, improve practice, or effectively manage the impacts of obesity. The objective of this project was to use a mixed-methods, stakeholder-driven approach to 1) understand the prevalence of obesity in populations served by CHCs 2) inform potential new CQMs to better assess and promote healthy weight in childhood 3) test the implementation of these CQMs in real-world settings and 4) support CHCs in their response to pediatric obesity via a guideline-based learning collaborative and quality improvement initiative.

Design/Methods: In partnership with the CDC and National Association of Community Health Centers (NACHC), AllianceChicago (a network of over 70 CHCs) engaged CHCs in exploring new pediatric weight management CQMs. Feedback on evidence-based, potential measures was gathered from CHC pediatricians through surveys and qualitative data collection regarding clinical significance, and ease of data capture. The feasibility of calculating CQMs was examined using patient data from Electronic Health Records from 2019, 2021, and 2022. A refined list of CQMs aligning with the 2023 AAP Clinical Practice Guidelines was tested in a QI initiative among CHC collaborators. In a subsequent initiative, CHCs are engaged in an evidence-based, practical learning collaborative and quality improvement project to support clinical weight management.

Results: Data analysis from a national cohort of CHCs revealed a prevalence of obesity significantly exceeding national rates. The prevalence of obesity increased from 2019 to 2021 (with highest increase in children 6-11 years old) and decreased in 2022. Data revealed opportunities to improve practice in screening for obesity related conditions, food insecurity, and follow-up that promotes behavior change. A measure testing pilot involving 2 potential CQMs demonstrated feasibility and high acceptance for implementation. In the second cohort, CHCs have been highly receptive to the learning collaborative and motivated to design quality improvement initiatives tailored to the populations they serve.

Conclusion/Discussion: Engaging stakeholders in measure development is essential to ensure feasibility and clinical relevance of quality measures. The results from these initiatives demonstrate that the prevalence of obesity in resource limited settings is higher than national rates and that meaningful quality measures can be implemented with high acceptance in community healthcare settings. This project highlights the vital role of CHCs in addressing pediatric obesity, the need for feasible quality measures and patient-centered interventions, and the need for advocacy for underserved communities.