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WCC Presentation 0 Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents Presented by: Healthcare Outcomes and Analysis LA Care Health Plan September 30, 2010

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WCC Presentation Presentation Purpose: 1 Best Practices for documenting record for the new measure Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents (WCC) Proper documentation of WCC visit(s) reflect a better quality of care for patients and a positive feedback for providers participation to encourage children and adolescent wellness.

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WCC Presentation WCC - Background: 2 Obesity In Children and Teens The problem of childhood obesity in the United States has grown considerably in recent years. Statistics/Facts: Between 16 and 33 percent of children and adolescents are obese. Obesity is among the easiest medical conditions to recognize but most difficult to treat. Unhealthy weight gain due to poor diet and lack of exercise is responsible for over 30,000 deaths each year. The annual cost to society is estimated at nearly $100 billion. Overweight children are much more likely to become overweight adults unless they adopt and maintain healthier patterns of eating and exercise.

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WCC Presentation According to a study conducted by CDC in 2004, 16% of children (over 9 million) 6-19 years of age are overweight or obese. This number is three times the population in 1980. 1 In addition to the three-fold increase, obesity has more than doubled in both children and adolescents from ages 2-5 and also ages 12-19. Similarly, the population more than tripled in children between 6-11 years old in the past three decades (according to this same study). 2 References: 1. Obesity In Children and Teens, American Academy of Child and Adolescent Psychiatry, May 2008 2. Prevalence of overweight and obesity among children and adolescents: United States, CDC, 2004 3 WCC Background (contin.):

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WCC Presentation 4 Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents (WCC): Is one of the newest HEDIS measures developed by the National Committee for Quality Assurance (NCQA) The measure consists of three (3) indicators: Body mass index (BMI) Counseling for Nutrition Counseling for Physical Activity WCC Background (contin.):

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WCC Presentation WCC - Body Mass Index (BMI) Indicator Documentation: 5 1.Body Mass Index documentation in the medical record should include date and BMI percentile &/or value depending upon the childs age BMI norms vary for children between the ages 3 to 15 years, so the BMI percentile should be recorded, not just the value. For 16-17 years of age, BMI value is acceptable.

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WCC Presentation WCC - BMI Indicator Calculation: The formula used to calculate BMI is as follows: Weight in Pounds BMI = ( (Height in inches) x (Height in inches) )x703 The pediatric height and weight charts can be found on the CDC website at: http://www.cdc.gov/growthcharts/data/set1clinical/set1color.pdf http://www.cdc.gov/growthcharts/data/set1clinical/set1color.pdf 6

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WCC Presentation WCC - Counseling for Nutrition Indicator Documentation: 7 2. Counseling for Nutrition Documentation must include a note indicating the date and at least one of the following: Discussion of current nutrition behaviors (e.g., eating and dieting behaviors) Checklist indicating nutrition was assessed Counseling or referral for nutrition education Member received educational materials on nutrition Anticipatory guidance for nutrition

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WCC Presentation WCC - Physical Activity Indicator Documentation: 8 3.Counseling for Physical Activity Documentation must include a note indicating the date and at least one of the following: Discussion of current physical activity behaviors (e.g., exercise routine, participation in sports activities and exam for sports participation) Checklist indicating physical activity was addressed Counseling or referral for physical activity Member received educational materials on physical activity Anticipatory guidance for physical activity

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WCC Presentation WCC Best Practices for Documentation: BMI Donts No BMI or BMI percentile documented in the medical record or plotted on age-growth chart Notation of height and weight only BMI or BMI percentile noted before or after the measurement year Entries on the BMI growth charts without an affiliated date Nutrition and Diet Donts No counseling/education on nutrition and diet Counseling/education before or after the measurement year Notation of health education or anticipatory guidance without any specific mention of nutrition 9

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WCC Presentation Physical Activity Donts No counseling/education on physical activity Notation of cleared for gym class alone without any documentation of a discussion Counseling/education before or after the measurement year Notation of health education or anticipatory guidance without any specific mention of physical activity 10 WCC Best Practices for Documentation (contin.):

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WCC Presentation Take advantage of any type of member visit, whether its for a well- child visit or sick visit to assess and counsel your patient on their BMI, nutrition, and physical activity. 11 WCC Best Practices for Documentation (contin.):

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WCC Presentation For questions, please contact: Carina Yapyuco, RN cyapyuco@lacare.org Theresa Colom, LVN tcolom@lacare.org cyapyuco@lacare.org tcolom@lacare.org 12