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The Impact of Six Sigma Implementation on Obesity Management in a Resident Outpatient Clinic Uchechi Egbuhuzo MD1, Kamilah Spencer MD1, Leila Njimoluh MD1,

Uchenna Onwuegbusi1, Preethi Kadambi MD1, Morayo Fakiya MD, CLSSBB1 1Department of Internal Medicine, Howard University Hospital

Critical to Quality (CTQ) Tree

Results of the identified “vital few” measures: The height documentation non-compliance rate decreased from 51.49% to 26.85% (a decrease of 47.85%, P = 0.001) and the sigma level was improved from 1.46 to 2.12. The BMI documentation non-compliance rate decreased from 50% to 18.79% (a decrease of 62.42%, P = 0.000) and the sigma level was improved from 1.5 to 2.39. The weight documentation non-compliance rate decreased from 39.55 % to 22.15% (a decrease of 43.99%, P = 0.002) and the sigma level was improved from 1.76 to 2.27.

Sigma level was improved from 1.76 to 2.27

Sigma level was improved from 1.5 to 2.39 Sigma level was improved from 1.46 to 2.12

Background

Control

Define

Measure

Outcome Statement

Analyze

Improve

Problem Statement: The United States Preventive Services Task Force (USPSTF) recommends that clinicians should screen all adult patients aged ≥18 years for obesity. Obese patients determined by a body mass index (BMI) of 30kg/m2 or higher should be managed with various interventions. In the 2013 academic year, our single internal medicine resident clinic located in an urban academic medical center in Washington, D.C. was only 50% compliant with BMI documentation. Moreover, there was non-compliance with several other measures related to total obesity management. Aim Statement: Decrease the non-compliance rates of the identified “vital few” measures related to obesity management of patients seen in the resident clinic by 30% over a four-month period. Interdisciplinary Team: Clinic attending physician who is a certified Six Sigma Black Belt , resident physicians, triage nurses and clinic manager.

MEASURE IMPROVE CONTROL ANALYZE DEFINE

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D.M.A.I.C Model of Six Sigma

Utilization of the DMAIC methodology of six sigma led to significant improvement in obesity screening in a resident continuity clinic of an urban academic medical center.

Effectiveness 1: Not very effective

5: Very effective

Feasibility 1 (low): Expensive & difficult to implement 5 (high): Inexpensive & easy to implement

A= Attending Physician B = Resident C = Triage Nurse

Effectiveness & Feasibility Matrix of Actions Taken

Pareto analysis of obesity management non-compliance The obesity epidemic in the United States has reached an all time high. Studies have shown that approximately 66% of Americans are overweight or obese. Of major concern is the rate of obesity in Washington, D.C. which is the 2nd highest in the country. Obesity has been shown to be directly correlated to chronic diseases such as diabetes mellitus type 2, asthma, heart disease, stroke, and some cancers. In Washington, D.C., 5 of the top 10 causes of death are directly related to diet, physical activity, and weight status. Due to these associations, obesity has health, economic, and psychosocial consequences.

Unfortunately, minority populations and those of low socioeconomic status are disproportionately impacted by obesity. Obesity is significantly higher in African-American and Latino communities compared to Caucasian populations. In 2012, 9.6 % of Caucasian D.C. residents were obese, while 33.7% of blacks were obese. Our urban academic medical center caters to a mostly African-American population.

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