Community Connections: Linking Primary Care Patients to Local Resources for Better Management of Obesity

• Use EHR to search by ICD-9 code or medication codes.
• This can also be done by 'chart mining' if no EHR is available. Slow, but still effective.

• Non-specific obesity: 270.00
  (BMI 30 and above—will not capture overweight).
• Abnormal Blood Glucose: 790.2
  (790.21, 790.22, 790.23).
• Could add hypertension, hyperlipidemia.

• Use practice management/billing system to search by appointment type or services billed.

• Any billable service possibly associated with obesity: diabetes, hypertension, hyperlipidemia, osteoarthritis, depression, etc.

• Ask contracting health care plans for their most recent lists that might include patients with obesity.

• Example: ask each health care plan for a list of all patients who started on diabetes medication over the last year.

• Update in real time with each office visit.

• When patients come in with the diagnosis of obesity, add their name to the registry.

For an excellent article on simple methods of querying patients: White, B. Improving Patient Care: Building a Patient Registry From the Ground Up. Fam Pract Manag 1999 Nov-Dec;6(10):43-44. http://www.aafp.org/fpm/1999/1100/p43.html.