Meeting Summary: September 18, 2003

Chair: Paula Armbruster   Vice-Chair: Mikki Meadows

HUSKY Obesity Services

·         The matrix for ‘Accessing Obesity- Related Services in the Husky Programs” was reviewed.  Dr. Karen Dorsey, a Yale Pediatrician and fellow with the Child Health & Development Institute (CHDI) stated that the Centers for Disease Control (CDC) defines obesity in children based on DCD growth charts and the differences should be reflected in the matrix:

o       For those aged 6-19 years, obesity is defined as at or above the sex & age specific 95^th percentile of Body Mass Index (BMI). Overweight is at or above the 85% BMI.

o       In adults, obesity is defined as a BMI of 30kg/m2 or more; overweight is a BMI of 25kg/m2 or more.

·         It is difficult to identify the prevalence of obesity in the HUSKY population if the office visit is not coded as an obesity assessment/intervention visit.  Dr. Dorsey shared information from a study she had conducted in a Community Health Clinic.  The purpose of the visit was to identify the burden of obesity in the clinic patient population and health practitioner behavior specific to obesity.  This information was obtained through an audit of 600 charts of those 3-17 years seen in the clinic in a two-year interval between CY1999-2000. The review showed:

o       The BMI was documented in 1% of the charts: 19% had a notation of overweight..

o       38% of the population a >85% BMI; of these, 20% were >95% BMI  (calculated by the researcher with the height/weight, age & sex chart information).

o       Of the 38% subset, 47% were Latino, 49% were adolescent (13-17 years), 23% were aged 3-5 years were classified as overweight/obese.

o       16% of the 38% with >85% BMI had treatment documentation.

o       7% of those children calculated to be in the 85-95^th% had a diagnosis of obesity in the chart, 5% of those in the 90-95^th %, 13% of those in the 95-97^th %, 26% in the 97-99^th % and 57% of those with a BMI > 99%.

Further discussion led to ‘next steps’

ü      Re-convene the Obesity work group, starting before the next QA meeting, identify the best time for practitioners, MCOs, state agencies to meet in the future.

ü      Revise the HUSKY grid to reflect the child/adult BMI ranges (see added document).

ü      Look at feasibility of providers routinely identifying the overweight/obese HUSKY individual & family, possible interventions given limited office visit time (i.e. nutritional referral resources, community/school physical activity program), professional guidelines for clinical evaluation of the overweight/obese child to assess co-morbidities.

Updates:  The concept paper for the grant proposal for comprehensive adolescent health care is being finalized for submission.  The proposal is based on the recommendations approved by the QA subcommittee and Medicaid Managed Care Council.

CT Dietetic Association forum on “The Child Nutrition paradox: Overweight yet Undernourished” at the Aqua Turf Club, Planstville CT on November 4.  Information is on www.eatrightct.org.

At the next meeting, Thursday October 23, 10:30 AM in LOB RM 3800 conference room, the subcommittee will be asked to review the 1) priority areas for the subcommittee and 2) data requests from DSS & the HUSKY MCOs. 

1)      See accompanying review of issues raised in the QA subcommittee for your consideration.

2)      The Chair & Vice-Chair met with Rose Ciarcia & Hilary Silver (DSS) on October 1 to discuss HUSKY data reports.  These will be discussed at the QA SC meeting:

·        ED/hospital admissions: most common reasons by diagnosis for adults & children in HUSKY.

·        Diabetes & obesity as a risk factor (see above bullet).

·        Missed appointments:  the department suggested looking at the MCO dental projects for information.  Paula Armbruster noted that her experience in the YCS clinic and PCP comments at the QA SC suggest that the population with chronically missed health care appointments represent a marginalized group of families for whom some type of intervention may be indicated to encourage participation in their or their children’s health care.

·        Percentage of children and adults with persistent asthma who received appropriate asthma medications to control their asthma (New York State Managed Care Plan Performance measure).

·        Elevated lead levels (from the DSS/DPH lead screen match) with communication with MCOs & health providers for follow up care.

·        Evidence of oral health care for pregnant women in the HUSKY program.