Implementing a novel electronic health record approach to track child sugar-sweetened beverage consumption

Prev Med Rep. 2018 Jun 19:11:169-175. doi: 10.1016/j.pmedr.2018.06.007. eCollection 2018 Sep.


Sugar-sweetened beverage (SSB) consumption is a risk factor for childhood obesity. Including this measure in electronic health records (EHR) could enhance clinical care and facilitate research on this topic. We implemented a single-item, EHR screening question for SSB and 100% fruit juice at 8 pediatric practices affiliated with a North Carolina academic medical center. From March-December 2017, we evaluated SSB screening of children 6 months-17 years of age. In a sub-sample of screened patients, we also conducted a telephone-based validation survey, comparing EHR-based responses to a lengthier beverage questionnaire, using Spearman rank coefficients and Kappa statistic. 22,626 children (91% of all seen) were screened for SSB intake. The screened population was diverse - 35% non-Hispanic White, 26% African-American, and 30% Hispanic. Consistent with national estimates, reported intake was typically higher than recommended: 41% (n = 9220) reported consuming SSB or fruit juice >1×/day in the past month, and consumption was higher among race/ethnic minorities. Of 201 validation survey respondents, direct correlation between their beverage survey and EHR screener responses was moderate, with a Spearman's rank correlation coefficient of 0.41 (p < 0.001) and Kappa statistic of 0.42 (95% CI 0.24-0.60). EHR-based screening for SSBs and fruit juice was successfully implemented, generating a large volume of SSB consumption data in a diverse patient population. Inclusion of patient-reported dietary measures in the EHR is feasible and could be useful for clinical care and research. Planned modifications may improve the correlation of such a screener with lengthier dietary instruments.

Keywords: Childhood obesity; Electronic health record; Sugar-sweetened beverages.