Sweetened Beverage Screening QI Project 

WHFHC 2011-2012

Youtube clip “Man eating sugar. New York City Health Department”

BackgroundChildren younger than 12 yr old

account for only 18% of the US total population, but consume 28% of all juice and juice drinks

By 1 year of age, almost 90% of infants consume juice.

Toddlers consume a mean of ~ 6 oz/day of juice. Almost 20% of children 2-5 years old drink more than 12 oz/day.

Between 56% and 85% of children consume at least 1 soft drink daily in school.

AAP recommendationIntake of fruit juice should be limited to 4 to 6

oz/d for children 1 to 6 years old. For children 7 to 18 years old, juice intake should be limited to 8 to 12 oz or 2 servings per day.

“The Use and Misuse of Fruit Juice in Pediatrics”, Pediatrics, May 2001

Why do we care?

Our Aim 

Our aim is to improve rates of nutritional screening for sweetened beverage consumption in children ages 2-6 years old from the July 2011 baseline of 46% to 80% by the end of the academic year with emphasis on promoting reduction of total daily consumption to 6 fl oz or less.

 

Baseline data

Percentage of charts recorded

PDSA Cycles

Cycle #1: November 2011, Use CHALK handout as both nutrition counseling and prompt to providersTo be given to parent by PFA at time of

registrationZero pts received handout

PDSA CyclesCycle #2: December 2011, Didactic session for

providers on sugary beverage counseling, MA attaches sugary beverage questionnaire to chart as prompt for providers

100% of patients 2-6 yrs received formChart review of those visits where handout was

given:

75% providers checked off dietary concerns

58% providers checked off juice/sweetened beverages

Top counseling points for providers

1. Limit sweetened beverage intake1-6yo: 4-6 oz7-18yo: 8-12 oz

2. Whole fruits are superior

3. Read labels to check for 100% juice content

4. Juice should be part of meal or snack, not sipped throughout day

5. Do not give unpasteurized juice

PDSA Cycles cont Cycle #3: March, 2012, Efficacy of screening to

increase provider by-in (and hopefully continue to increase screening rates and documentation)

0/6 patients mentioned the link between sweet beverages and obesity

3/6 associated them with hyperactivity, 1/6 mentioned cavities

Cycle #4: Create English/Spanish hand-out emphasizing link between sugary beverage intake and obesity

Poll parents re: efficacy of handout Survey parents re: link between sugary beverages and obesity before

and after WCC Survey providers

PDSA Cycle #4: Efficacy of handout – do parents like it?

Parents opinion:

100% pointed to picture as helpful 

0% found the handout unclear

100% correctly summarized handout in their own words

88% stated they were already aware of sugar-fat connection

100% felt handout was useful to reinforce message 

Efficacy of Handout – is it helping during visits?

Post visit questionnaire:

Has your opinion about the amount of juice your child drinks changed? If so, how?

Has your opinion about sweet beverages changed? If so, how?

Did your doctor use the handout to discuss these issues with you

Efficacy of handout - Provider survey

80% found handout clear

100% thought handout gave right message

80% thought handout would be helpful

98% maybe to very likely to use handout

End of year data review

Percentage of charts recorded

Conclusion Childhood obesity is an extremely challenging but important issue

to tackle within pediatrics.

Sweetened beverage intake is an important contributor to excess calories, which may lead to obesity.

We are doing a good job with counseling – but what are parents hearing?

Handout helps parents see link between sugary and obesity and may help with physician screening

Limitations

Provider-only project

PDSA cycles and chart reviews did not include BMI

Medically complex patients

What can we spreadNew handout!

References Gidding, S.S., Dennison, B.A., Birch, L.L., et al. AHA Scientific Statement: Dietary

Recommendations for Children and Adolescents, A Guide for Practitioners. American Heart Association. Sept 2005.

Baker, S.S., Cochran, W.J., Greer, F.R, et al.  The Use and Misuse of Fruit Juice in Pediatrics.  American Academy of Pediatrics Committee on Nutrition. Vol 107 No. 5 May 2001.

Spear, B.A., Barlow, S.E., Ervin, C., et al. Obesity Recommendations for Treatment of Child and Adolescent Overweight and Obesity. Pediatrics. 2007. 120;S254.

American Academy of Pediatrics, The use and misuse of fruit juice in pediatrics. Pediatrics. 2001

New York City Department of Health anti-sugar campaign

THANK YOU 181st!Attendings: Annie Armstrong, Steve Caddle, Melanie Gissen, Rebecca

Friedman, Adriana Matiz, Dodi Meyer, Kim Noble, John Rausch, Minna Saslaw, Dana Sirota

Residents: Edna Akoto, Serine Avagyan, Emily Eida, Anna Gay, Carly Gomes, Faith Ihekweazu, Laura Kurek,Ted Macnow, Amy Ost, Sarah Richman, Vanessa Salcedo, Zoya TreysterKristen Williams, Jason Winkler, Daniel Yu

MAs: Aurora Gomez, Maribel Jimenez, Carmen Nicasio, Petra Ortiz, Candida Rodriguez

RNs: Joan Mahoney, Jessie Mane, Gerthy Michel

PFAs: Cindy Ferrer, Sheila Grant Mclean, Jasmin Pena, Ivelisse Rodriguez, Lelanie Vinales