PIP QI reports: a closer look at the BMI measure and how we can help general practice

  21 September 2021  Dr Jeannie Knapp, GP and Primary Health Care Improvement GP Adviser, NWMPHN

How can our PIP QI reports help manage patient BMI for general practice?

About our PIP QI reports

North Western Melbourne Primary Health Network (NWMPHN) is continuing to provide individual quarterly PIP QI reports for any general practice in the region wanting to use data to drive improvement.

These reports are based on the 10 measures for the Practice Incentives Program Quality Improvement (PIP QI) Incentive.

Remember: you can choose any area of data driven quality improvement for the PIP QI Incentive, as long as you are working in partnership with NWMPHN. However, the 10 measures have been chosen as evidence-based measurements and are the ideal starting point for a QI activity.

In this article we are taking a closer look at PIP QI Measure 3: Proportion of regular patients aged > 15 with a BMI recorded in the last 12 months.

Why is measuring BMI important?

Excess weight, especially obesity, is a major risk factor for cardiovascular disease, type 2 diabetes, some musculoskeletal conditions and some cancers.

As the level of excess weight increases, so does the risk of developing these conditions. In addition, being overweight can hamper the ability to control or manage chronic conditions.

What do the statistics say?

  • In 2015, 8.4 per cent of the total burden of disease in Australia was due to overweight and obesity.
  • Australia had the sixth highest proportion of overweight or obese people aged 15 years or over among 22 OECD member countries in 2019.
  • In 2017–18, 31 per cent of Australian adults were obese, an increase from 19 per cent in 1995.

Source: Australian Institute of Health and Welfare.

What is BMI?

BMI is an internationally recognised standard for classifying overweight and obesity in adults. While BMI measurement is not perfect, at a population level BMI is a practical and useful measure for monitoring overweight and obesity.

Recording of BMI status keeps our records up to date and prompts us to have conversations about weight and associated risk factors with appropriate populations. This can lead to evidence-based interventions.

How good are we at recording this now?

In the latest data collected in the NWMPHN catchment, 17.32 per cent of patients had a current BMI status recorded. If the ideal rate is 100 per cent, how do you feel about this result?

Now, look at your own report.

  • How do you compare to the NWMPHN average?
  • How do you feel about your result? Is it higher or lower than you expected?
  • What are the factors unique to your practice that you think influences the result?

Is 100 per cent ever achievable? Discussing weight can be a sensitive topic. What is a good target to aim for? 80 or 90 per cent? Think about what is achievable at your practice.

Set a goal

Plan

Make a plan of how you are going to improve your BMI recording rates. An important step in making changes is to have an overall goal to work towards, with a definable measure.

Goal

For example: your practice may aim to improve the proportion of active patients with a BMI status recorded from 60 per cent to 70 per cent.

Measure

Percentage of active patients with a BMI status recorded at baseline and 6 months after making changes.

Tips to improve the recording of BMI at your practice

Around the practice

  • Install Topbar. This helps by highlighting which patients with do not have their BMI status recorded.
  • Include height and weight recording on new patient registration forms. Have a process in place for who translates the data into the clinical file.
  • Conduct targeted blitzes in your practice to increase recording of BMI status. For example: you could print some cards for reception to hand out that say “This month we are updating everyone’s BMI status. You will be asked in your consultation if your BMI status is correct and up to date.”
  • Designate a particular day each week to focus on it. For example: ‘Weight and Height Wednesdays.”
  • If your practice nurse has time, they might see patients while they are waiting for the GP, to record their height and weight.

As a team

  • Consider a team meeting and education session. Discuss correct recording (‘coding’) of weight and height information with clinical staff members. Make sure everyone knows how to put the data in the correct area of the software and how to code the data correctly. Note: responses that are written in the progress notes are not able to be considered recorded.
  • Brainstorm ideas in your team to help improve BMI recording. You might form a project team.

Do it, study it, and act on any changes you want to make

The final step of the Plan, Do, Study, Act (PDSA) cycle is to do what you planned to do: test the ideas, study and reflect on what happened, and make any changes that can continue to improve your work.

For example: you might find that some patients were challenged by the card handout and instead preferred a more personalised approach.

More information

NWMPHN has developed several toolkits which can assist you in tackling improvement in this measure. More information on our quality improvement program and toolkits is available on our website.

Details on how to use the PIP QI reports is available on the Pen CS website.

If you have any questions about quality improvement, please contact us on (03) 9347 1188 or email primarycare@nwmphn.org.au

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Visit the Management of Overweight and Obesity in Adults page on Health Pathways Melbourne for assistance on how assess and manage smoking within your practice.

Are you a GP or health professional in our region who doesn’t have access to HealthPathways Melbourne? Request access online or contact info@healthpathwaysmelbourne.org.au