Obesity, (BMI>95%), Overdue for lipid profile

Clinician Summary

The American Diabetes Association (ADA) consensus panel recommends that overweight individuals (BMI >85%) at high risk for developing Type II Diabetes should be screened starting at age 10, or at onset of puberty if it occurs earlier. Individuals are defined as being at High Risk based on family history of Type II diabetes, race/ethnicity, signs of or conditions associated with insulin resistance (acanthosis nigricans, HTN, dyslipidemia, PCOS).

This reminder prompts clinicians to screen High Risk individuals who have the following recorded indicators within the electronic health record (EHR) system:

10 ≥ Age ≤ 18; and
BMI>95% at least once within the last 24 months; and
most recent LDL is older than 24 months; and
most recent total cholesterol is older than 24 months; and
patient has a recorded height and weight within the last 24 months

References

1. Type 2 diabetes in children and adolescents. American Diabetes Association. Diabetes Care. 2000 Mar;23(3):381-9.

2. Prevention of Pediatric Overweight and Obesity. Pediatrics. 2003 Aug;112(2):424-430.

3. Obesity Evaluation and Treatment: Expert Committee Recommendations. Pediatrics. 1998 Sep;102(3):e29.

Web Links

1. American Academy of Pediatrics: http://pediatrics.aappublications.org/content/112/2/424

2. Bright Futures: http://brightfutures.aap.org/clinical_practice.html

Implementation Notes

Rule category	Obesity
Rule title	Obesity, high BMI, Overdue for lipid profile
Primary Clinical Area	Pediatrics
Secondary Clinical Area
Risk Group Definition	age ≥ 10 yrs AND age ≤18 yrs and BMI >95%
Details for Risk Group	BMI % calculated flowsheet
Triggering Condition	Most recent total cholesterol ≥ 24 months and most recent LDL ≥ 24 months and last record of BMI < 24 months
Details for Triggering	LDL, total cholesterol, For BMI, the most recent height and weight must be within the past 24 months.
Condition	If either height or weight is more than 24 months old, patient does not belong to this risk group.
Displayed Message	Patient’s BMI >95%. Consider lipid profile every 1 to 2 years.
Coded Responses	Snooze Periods
A: Done/Scheduled B: Patient Refuses C: Deferred D: Other E: Done elsewhere F: G:	A': 2 years B': 6 months C': 3 months D': 1 month E': 2 years F': G':

Disclaimer

These rules and/or reminders were created using national, state and local guidelines, and group consensus regarding best practices. These guidelines, and their interpretation by clinicians at Partners Healthcare System, may not represent the standard of care across all regions or settings, and are not intended to be adopted or applied without independent assessment of their suitability for a particular setting. Moreover, guidelines change over time (for example, the age range for children who should receive influenza vaccinations was recently extended to 59 months). The rules and/or reminders may need the addition or modification of certain items to ensure that they remain consistent with current guidelines. Therefore, the rules and/or reminders included here are intended only as examples or guides for the development of similar rules and/or reminders in other settings. Partners Healthcare System and its affiliates disclaim any and all responsibility or liability associated with the use of the rules and/or reminders displayed here by third parties.