eCQM Title

Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents

eCQM Identifier (Measure Authoring Tool) 155 eCQM Version number 7.2.000
NQF Number 0024 GUID 0b63f730-25d6-4248-b11f-8c09c66a04eb
Measurement Period January 1, 20XX through December 31, 20XX
Measure Steward National Committee for Quality Assurance
Measure Developer National Committee for Quality Assurance
Endorsed By National Quality Forum
Percentage of patients 3-17 years of age who had an outpatient visit with a Primary Care Physician (PCP) or Obstetrician/Gynecologist (OB/GYN) and who had evidence of the following during the measurement period. Three rates are reported.

 - Percentage of patients with height, weight, and body mass index (BMI) percentile documentation
 - Percentage of patients with counseling for nutrition
 - Percentage of patients with counseling for physical activity
This Physician Performance Measure (Measure) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure.   The Measure can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2017 National Committee for Quality Assurance. All Rights Reserved. 

Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any third party codes contained in the specifications.

CPT(R) contained in the Measure specifications is copyright 2004-2017 American Medical Association. LOINC(R) copyright 2004-2017 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R] ) copyright 2004-2017 International Health Terminology Standards Development Organisation. ICD-10 copyright 2017 World Health Organization. All Rights Reserved.
The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.
Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].
Measure Scoring Proportion
Measure Type Process
Report a total score, and each of the following strata:
Stratum 1 - Patients age 3-11  
Stratum 2 - Patients age 12-17
Risk Adjustment
Rate Aggregation
One of the most important developments in pediatrics in the past two decades has been the emergence of a new chronic disease: obesity in childhood and adolescence. The rapidly increasing prevalence of obesity among children is one of the most challenging dilemmas currently facing pediatricians. National Health and Nutrition Examination Survey (NHANES) data from Cycle II (1976-1980) compared with data from Cycle III (1988-1994) documents an increase in the prevalence of obesity in all age, ethnic, and gender groups. NHANES data collected from 1999-2000 revealed a continued increase in the number of obese children. In that data collection, the prevalence of obesity (body mass index (BMI) > 95th percentile) was 10 percent among children 2-5 years of age and 15 percent among children 6-19 years of age. When children at risk for obesity (BMI of 85th-94th percentile) were included, the prevalence increased to 20 percent and 30 percent, respectively. Therefore, >1 of every 4 patients examined by pediatricians either is obese or is considered to be at high risk for developing this challenging health problem (O'Brien et al. 2004).

In addition to the growing prevalence of obesity in children and adolescents, the number of overweight children at risk of becoming obese is also of great concern. Evidence suggests that overweight children and adolescents are more likely to become obese as adults. For example, one study found that approximately 80 percent of children who were overweight at age 10-15 years were obese adults at age 25 years (Whitaker et al. 1997). Another study found that 25 percent of obese adults were overweight as children. The latter study also found that if overweight begins before 8 years of age, obesity in adulthood is likely to be more severe (Freedman et al. 2001).
Clinical Recommendation Statement
U.S. Preventive Services Task Force (USPSTF) (2017) - The USPSTF recommends that clinicians screen for obesity in children and adolescents 6 years and older and offer or refer them to comprehensive, intensive behavioral interventions to promote improvements in weight status. (B recommendation)
American Academy of Pediatrics (2004) - BMI should be calculated from the height and weight, and the BMI percentile should be calculated.

American Medical Association (AMA), Centers for Disease Control and Prevention (CDC), Health Resources and Services Administration (HRSA) (2007) - At minimum, a yearly assessment of weight status in all children.

Include calculation of height, weight (measured appropriately), and body mass index (BMI) for age and plotting of those measures on standard growth charts.

The AAP and the American College of Clinical Endocrinology (ACCE) (Dorsey 2005) - Screen children for obesity using BMI and examine overweight children for obesity-related diseases.

CDC (Baker 2005) - Using the percentile BMI for age and sex as the most appropriate and easily available method to screen for childhood overweight or at risk for overweight. 

Bright Futures (AAP) (Hagan 2008) - Calculate BMI at every visit.
Improvement Notation
Higher score indicates better quality
O'Brien, S.H., R. Holubkov, E.C Reis. 2004. "Identification, evaluation, and management of obesity in an academic primary care center." Pediatrics 11:154-159.
Whitaker, R.C., J.A. Wright, M.S. Pepe, K.D. Seidel, W.H. Dietz. 1997. "Predicting obesity in young adulthood from childhood and parental obesity." N Engl J Med 37(13):869-873.
Freedman, D.S., L.K. Khan, W.H. Dietz, S.R. Srinivasan, G.S. Berenson. 2001. "Relationship of childhood overweight to coronary heart disease risk factors in adulthood: The Bogalusa Heart Study." Pediatrics 108:712-718.
U.S. Preventive Services Task Force (USPSTF). 2017. Screening and interventions for overweight in children and adolescents: recommendation statement. Rockville: Agency for Healthcare Research and Quality (AHRQ).
[AAP] National High Blood Pressure Education Program Working Group on High Blood Pressure in Children. 2004. "The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents." Pediatrics 114(2 Suppl):555-76.
AMA/HRSA/CDC Expert Committee on the Assessment, Prevention and Treatment of Child and Adolescent Overweight and Obesity. 2007. Recommendations on the assessment, prevention and treatment of child and adolescent overweight and obesity. Chicago: AMA. 
Dorsey, K.B., C. Wells, H.M. Krumholz, J.C. Concato. 2005. "Diagnosis, evaluation, and treatment of childhood obesity in pediatric practice." Arch Pediatr Adolesc Med 159:632-638.
Baker, S., S. Barlow, W. Cochran, G. Fuchs, W. Klish, N. Krebs, R. Strauss, A. Tershakovec, J. Udall. 2005. "Overweight children and adolescents: a clinical report of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition." J Pediatr Gastroenterol Nutr 40(5):533-43.
Hagan, J.F., Shaw J.S., Duncan P.M. eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove: American Academy of Pediatrics.
The visit must be performed by a PCP or OB/GYN. 
Because BMI norms for youth vary with age and sex, this measure evaluates whether BMI percentile is assessed rather than an absolute BMI value.
Transmission Format
Initial Population
Patients 3-17 years of age with at least one outpatient visit with a primary care physician (PCP) or an obstetrician/gynecologist (OB/GYN) during the measurement period
Equals Initial Population
Denominator Exclusions
Patients who have a diagnosis of pregnancy during the measurement period.

Exclude patients whose hospice care overlaps the measurement period.
Numerator 1: Patients who had a height, weight and body mass index (BMI) percentile recorded during the measurement period
Numerator 2: Patients who had counseling for nutrition during the measurement period
Numerator 3: Patients who had counseling for physical activity during the measurement period
Numerator Exclusions
Not Applicable
Denominator Exceptions
Supplemental Data Elements
For every patient evaluated by this measure also identify payer, race, ethnicity and sex

Table of Contents

Population Criteria




Data Criteria (QDM Data Elements)

Supplemental Data Elements

Risk Adjustment Variables

Measure Set