Impact of electronic medical record utilization on obesity screening and intervention for obese patients with endometrial cancer (412)

Abstract

<b>Objectives:</b> Obesity has been identified as a modifiable risk factor associated with increased morbidity and mortality in endometrial cancer. The electronic medical record (EMR) problem list is a powerful but often underutilized tool for clinical decision-making. There is a paucity of data on how the EMR may be leveraged to optimize the management of obesity and initiate weight-loss interventions. Our study aimed to identify the prevalence of obesity documented on the EMR problem list and describe the completion of obesity interventions. <b>Methods:</b> We performed a retrospective cohort study of all obese patients with endometrial cancer receiving care at our institution from January 1, 2018, to August 20, 2021. Tumor registry confirmed endometrial cancer cases were identified using International Classification of Disease - Oncology (ICD-O) codes from our institution's Research Derivative database. The inclusion criteria were age >18, BMI ≥30 kg/m², and at least two visits with a gynecologic oncologist at our institution. The first BMI on record at the index visit was used for inclusion. Patients were excluded if BMI data was not available. Obesity intervention was defined as any of the following metrics: referral to a medical weight loss clinic, referral to nutrition, completion of the obesity intervention tab in EPIC, or counseling about the importance of weight loss. Completion of referral to nutrition and obesity weight loss clinic were captured. Weight loss counseling was defined by documentation of weight loss counseling in any gynecologic oncology provider visit note. <b>Results:</b> We identified 158 patients who met our inclusion criteria. Median BMI was 38 (range: 30-73), the median age was 66 years, and most patients identified as White (89%). Of eligible patients, 73 (46%) had obesity, or BMI documented on their problem list; 39 (25%) had completion of any obesity intervention. Specific interventions included weight loss counseling (<i>n</i> = 34, 22%), obesity health maintenance intervention completed in EPIC (<i>n</i> = 30, 19%), nutrition referral (<i>n</i> = 4, 3%), and medical weight loss center referral (<i>n</i> = 8, 5%). Only two patients who were referred to nutrition completed those visits, and only three patients who were referred to the medical weight loss center completed these visits. In the univariate logistic regression, patients with BMI or obesity on the problem list were 2.6 times more likely to have completion of obesity intervention (OR: 2.6, 95% CI: 1.24-5.59, p<0.001). <b>Conclusions:</b> EMR problem list to document obesity among endometrial cancer patients was used less than half of the time. Less than a quarter of eligible patients had the opportunity to engage in an obesity intervention. The EMR is not being leveraged to its full potential to encourage the usage of obesity interventions for this patient population. Improved compliance with these tools in the EMR may improve referral to and completion of weight-loss interventions.