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## Complete Summary

#### TITLE

Prevention and management of obesity (mature adolescents and adults):
percentage of patients with a documented Body Mass Index (BMI) equal to
or greater than 25 who were given education and counsel for weight loss
strategies.

#### SOURCE(S)

Institute for Clinical Systems Improvement (ICSI). Prevention and
management of obesity (mature adolescents and adults). Bloomington (MN):
Institute for Clinical Systems Improvement (ICSI); 2006 Nov. 105 p.
\[226 references\]

### Measure Domain

#### PRIMARY MEASURE DOMAIN

Process

The validity of measures depends on how they are built. By examining the
key building blocks of a measure, you can assess its validity for your
purpose. For more information, visit the [Measure
Validity](http://www.qualitymeasures.ahrq.gov/resources/measure_domains.aspx)
page.

#### SECONDARY MEASURE DOMAIN

Does not apply to this measure

### Brief Abstract

#### DESCRIPTION

This measure is used to assess the percentage of patients with a
documented body mass index (BMI) equal to or greater than 25 who were
given education and counsel for weight loss strategies.

#### RATIONALE

The priority aim addressed by this measure is to improve the percentage
of patients who have received education and counsel regarding weight
loss.

#### PRIMARY CLINICAL COMPONENT

Obesity; education; weight loss strategies (nutrition, physical
activity, lifestyle changes, medication, surgery)

#### DENOMINATOR DESCRIPTION

Number of patients 18 years of age and older with body mass index (BMI)
greater than or equal to 25

#### NUMERATOR DESCRIPTION

Number of patients with a documented body mass index (BMI) greater than
or equal to 25 who were given education and counsel for weight loss,
which should include: nutrition, physical activity, lifestyle changes,
medication and/or surgery

### Evidence Supporting the Measure

#### EVIDENCE SUPPORTING THE CRITERION OF QUALITY

-   A clinical practice guideline or other peer-reviewed synthesis of
    the clinical evidence

#### NATIONAL GUIDELINE CLEARINGHOUSE LINK

-   [Prevention and management of obesity (mature adolescents and
    adults).](http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=10226)

### Evidence Supporting Need for the Measure

#### NEED FOR THE MEASURE

Unspecified

### State of Use of the Measure

#### STATE OF USE

Current routine use

#### CURRENT USE

Internal quality improvement

### Application of Measure in its Current Use

#### CARE SETTING

Physician Group Practices/Clinics

#### PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Physicians

#### LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Group Clinical Practices

#### TARGET POPULATION AGE

Age greater than or equal to 18 years

#### TARGET POPULATION GENDER

Either male or female

#### STRATIFICATION BY VULNERABLE POPULATIONS

Unspecified

### Characteristics of the Primary Clinical Component

#### INCIDENCE/PREVALENCE

The prevalence of overweight and obese people is increasing worldwide at
an alarming rate in both developing and developed countries.
Environmental and behavioral changes brought about by economic
development, modernization and urbanization have been linked to the rise
in global obesity. Obesity is increasing in children and adults, and
true health consequences may become fully apparent in the near future.

Obesity has become a national epidemic in the United States (U.S.) with
32% of non-institutionalized adults being obese, and 66.3% being
overweight or obese. The most recent data suggest that 17% of
adolescents age 12 to 19 years are overweight and an additional 16% are
at risk for overweight.

#### EVIDENCE FOR INCIDENCE/PREVALENCE

Institute for Clinical Systems Improvement (ICSI). Prevention and
management of obesity (mature adolescents and adults). Bloomington (MN):
Institute for Clinical Systems Improvement (ICSI); 2006 Nov. 105 p.
\[226 references\]

Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM.
Prevalence of overweight and obesity in the United States, 1999-2004.
JAMA2006 Apr 5;295(13):1549-55.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16595758)

#### ASSOCIATION WITH VULNERABLE POPULATIONS

Unspecified

#### BURDEN OF ILLNESS

Obesity is the second leading cause of preventable death in United
States (U.S.), with only tobacco use causing more deaths. More than
110,000 deaths per year are associated with obesity.

#### EVIDENCE FOR BURDEN OF ILLNESS

Flegal KM, Graubard BI, Williamson DF, Gail MH. Excess deaths associated
with underweight, overweight, and obesity. JAMA2005 Apr
20;293(15):1861-7.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15840860)

Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in
the United States, 2000. JAMA2004 Mar 10;291(10):1238-45. \[97
references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15010446)

#### UTILIZATION

Unspecified

#### COSTS

The economic impact of obesity and its related health conditions on the
United States (U.S.) economy is staggering and has been estimated at
about \$118 billion in the late 1990s, or about 12% of the national
health care budget, according to the Worldwatch Institute in 2000.

#### EVIDENCE FOR COSTS

Institute for Clinical Systems Improvement (ICSI). Prevention and
management of obesity (mature adolescents and adults). Bloomington (MN):
Institute for Clinical Systems Improvement (ICSI); 2006 Nov. 105 p.
\[226 references\]

### Institute of Medicine National Healthcare Quality Report Categories

#### IOM CARE NEED

Getting Better\
Living with Illness

#### IOM DOMAIN

Effectiveness\
Patient-centeredness

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

Patients with a body mass index (BMI) greater than or equal to 25

If there is no electronic medical record, select 20 patients who have
had a visit within the last month who have a BMI greater than or equal
to 25. If the BMI is not documented, use the formula: BMI = weight (lbs)
x 703 divided by height (inches) squared.

The medical record will be reviewed to determine if one or more of the
weight management strategies have been documented. The presence of
narrative comments or flow sheets reflecting discussion of one or more
of the following weight-management strategies is acceptable evidence for
this measure: nutrition, physical activity, lifestyle changes,
medication and/or surgery.

If an electronic medical record is available, query data for patients
with a visit in the last month with a BMI greater than or equal to 25
(assuming this is a field in the electronic medical record \[EMR\]).

The medical record will be reviewed to determine if one or more of the
weight management strategies have been documented. The presence of
narrative comments or flow sheets reflecting discussion of one or more
of the following weight management strategies is acceptable evidence for
this measure: nutrition, physical activity, lifestyle changes,
medication or surgery.

The suggested time period is advice over a 12-month period.

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Number of patients 18 years of age and older with body mass index (BMI)
greater than or equal to 25

**Exclusions**\
Unspecified

#### RELATIONSHIP OF DENOMINATOR TO NUMERATOR

All cases in the denominator are equally eligible to appear in the
numerator

#### DENOMINATOR (INDEX) EVENT 

Clinical Condition\
Encounter

#### DENOMINATOR TIME WINDOW

Time window is a fixed period of time

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Number of patients with a documented body mass index (BMI) greater than
or equal to 25 who were given education and counsel for weight loss,
which should include: nutrition, physical activity, lifestyle changes,
medication and/or surgery

**Exclusions**\
Unspecified

#### MEASURE RESULTS UNDER CONTROL OF HEALTH CARE PROFESSIONALS, ORGANIZATIONS AND/OR POLICYMAKERS

The measure results are somewhat or substantially under the control of
the health care professionals, organizations and/or policymakers to whom
the measure applies.

#### NUMERATOR TIME WINDOW

Episode of care

#### DATA SOURCE

Medical record

#### LEVEL OF DETERMINATION OF QUALITY

Individual Case

#### PRE-EXISTING INSTRUMENT USED

Unspecified

### Computation of the Measure

#### SCORING

Rate

#### INTERPRETATION OF SCORE

Better quality is associated with a higher score

#### ALLOWANCE FOR PATIENT FACTORS

Unspecified

#### STANDARD OF COMPARISON

Internal time comparison

### Evaluation of Measure Properties

#### EXTENT OF MEASURE TESTING

Unspecified

### Identifying Information

#### ORIGINAL TITLE

Percentage of patients with a documented BMI equal to or greater than 25
who were given education and counsel for weight loss strategies.

#### MEASURE COLLECTION

[Prevention and Management of Obesity (Mature Adolescents and Adults)
Measures](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=26&doc=6116)

#### DEVELOPER

Institute for Clinical Systems Improvement

#### ADAPTATION

Measure was not adapted from another source.

#### RELEASE DATE

2004 Nov

#### REVISION DATE

2006 Nov

#### MEASURE STATUS

This is the current release of the measure.

This measure updates a previous version: Institute for Clinical Systems
Improvement (ICSI). Prevention and management of obesity (mature
adolescents and adults). Bloomington (MN): Institute for Clinical
Systems Improvement (ICSI); 2005 Nov. 100 p.

#### SOURCE(S)

Institute for Clinical Systems Improvement (ICSI). Prevention and
management of obesity (mature adolescents and adults). Bloomington (MN):
Institute for Clinical Systems Improvement (ICSI); 2006 Nov. 105 p.
\[226 references\]

#### MEASURE AVAILABILITY

The individual measure, \"Percentage of patients with a documented BMI
equal to or greater than 25 who were given education and counsel for
weight loss strategies,\" is published in \"Health Care Guideline:
Prevention and Management of Obesity (Mature Adolescents and Adults).\"
This document is available from the [Institute for Clinical Systems
Improvement (ICSI) Web
site](http://www.icsi.org/guidelines_and_more/guidelines__order_sets___protocols/).

For more information, contact ICSI at, 8009 34th Avenue South, Suite
1200, Bloomington, MN 55425; phone: 952-814-7060; fax: 952-858-9675; Web
site: [www.icsi.org](http://www.icsi.org/); e-mail:
<icsi.info@icsi.org>.

#### NQMC STATUS

This NQMC summary was completed by ECRI on December 20, 2004. This NQMC
summary was updated by ECRI on December 15, 2005 and again on January
23, 2007.

#### COPYRIGHT STATEMENT

This NQMC summary (abstracted Institute for Clinical Systems Improvement
\[ICSI\] Measure) is based on the original measure, which is subject to
the measure developer\'s copyright restrictions.

The abstracted ICSI Measures contained in this Web site may be
downloaded by any individual or organization. If the abstracted ICSI
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If the abstracted ICSI Measures are downloaded by an organization,
copies may be distributed to the organization\'s employees but may not
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consent of the Institute for Clinical Systems Improvement, Inc.

All other copyright rights in the abstracted ICSI Measures are reserved
by the Institute for Clinical Systems Improvement, Inc. The Institute
for Clinical Systems Improvement, Inc. assumes no liability for any
adaptations or revisions or modifications made to the abstracts of the
ICSI Measures.

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© 2008 National Quality Measures Clearinghouse

Date Modified: 11/3/2008