409 - Words Matter: The Effects of a Quality Improvement Intervention on Stigmatizing Language in Pediatric Primary Care Weight Management and Diet Related Chronic Disease Documentation

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 409
Publication Number: 409.146

Abraham V. Ipe, George Washington University School of Medicine and Health Sciences, Washington, DC, United States; Kofi Essel, Children's National Health System, Washington, DC, United States; Meera Krishnamoorthy, George Washington University School of Medicine and Health Sciences, Clarksburg, MD, United States; Kaleab Ribbiso, George Washington University School of Medicine and Health Sciences, Arlington, VA, United States; Richard Fagbemigun, George Washington University School of Medicine and Health Sciences, Washington, DC, United States; Adwoa Bamfo, George Washington University School of Medicine and Health Sciences, Falls Church, VA, United States; Alicia Tucker, Children's National Health System, Alexandria, VA, United States

Presenting Author(s)

Abraham V. Ipe, BS (he/him/his)

Medical Student
George Washington University School of Medicine and Health Sciences
Washington, District of Columbia, United States

Co-Author(s)

Alicia Tucker, MD, FAAP (she/her/hers)

Pediatrician at the Children's National IDEAL Clinic and Assistant Professor of Pediatrics at George Washington University School of Medicine
Children's National Health System
Alexandria, Virginia, United States

Background: Weight stigma remains prevalent within healthcare. A 2017 AAP policy statement outlined the detrimental impact of stigma in its many forms, including harmful language used by providers. In the context of the Cures Act, which grants patients unprecedented access to their health records, practices must ensure that destigmatizing language is used to promote positive health outcomes.

Objective: To reduce stigmatizing language in clinical documentation through educational and EHR interventions in the context of a clinical quality improvement (QI) initiative.

Design/Methods: A comprehensive QI project focused on improving the diagnosis and management of pediatric obesity was conducted at primary care centers affiliated with Children’s National Hospital in Washington, DC. Two health centers in Washington DC were identified for targeted interventions. 17 pediatricians from these centers were selected for monthly chart review conducted at baseline, during the 12 month initiative, and 6 months post-intervention. The project included the development of clinical algorithms, enduring educational materials, monthly coaching sessions, and EHR changes. Employing empathetic language was incorporated into the project's key drivers. While patient-first language was emphasized throughout, additional interventions targeted clinical documentation; 1) ICD code changed to “severe obesity” from “morbid obesity” in the EHR 2) documents disseminated outlining specific antiquated exam terminology 3) and removal of “weight check” for follow up visits.

Results: A significant decrease in the use of stigmatizing language (Table 1) was noted across both outpatient clinics. At baseline, 40% of all charts of patients with obesity included stigmatizing language. This number dropped by 20% and was sustained after the intervention. The terms “weight check,” “obese” within the general appearance section of the physical exam, and “buffalo hump” reached near zero and were sustained 6 months post-intervention (Figure 1). Improvements in all metrics were seen, with the only deviation being an increase in the use of inappropriate BMI coding during the 6-9 month period of intervention, isolated to a single provider.

Conclusion(s): This intervention demonstrates that replicable education interventions and institutional support in removing stigmatizing language from the EHR can significantly improve the use of patient sensitive language. As patients push for increased transparency from their clinicians, we need our written language to reflect the same person-first language that we are striving for within clinical encounters.