Clinical

As we continue to adapt to our new clinical norm, providing service seamlessly between telehealth and in person, we have developed new processes and supports for the increased variety of visit types. Additionally, we increased access to our services to meet increased demand. Group classes continue to be exclusively online, with an uptick in enrollment as we have restarted Jumpstart, our orientation sessions. We had 451 English-speaking and 48 Spanish speaking families attend Jumpstart to introduce them to our services. We had a total of 331 group visits serving 80

patients. We had a total of 4836 individual clinic visits in 2021, an 18% increase over 2020. In addition, the amount of care delivered by telehealth continues to increase, with 5% telehealth in 2019, 60% in 2020 and 74% in 2021.

Our Special Needs Weight Management clinic had 740 visits last year, on a continued upward trend over the last three years. New research projects are ongoing to look at outcomes specifically in children with Autism Spectrum Disorder and factors associated with success in the younger children with intellectual and developmental disabilities. Several patients from this clinic are either being followed for their post-op outcomes or are preparing

for bariatric surgery, with high levels of success. One patient and her mother who are preparing for surgery with the help of our team remarked, “The support of this team has been life changing for us.”

The Metabolic Bariatric clinic had 24 patients undergo gastric sleeve in 2021, a return to the pre-COVID numbers after only nine surgeries in 2020. Of note, four of those patients had their surgery at a different center in Kansas City, three due to insurance coverage and one due to need for more complicated surgery on a patient who is an adult. We had 810 clinical visits, an increase of 29 visits over the last year, which includes 163 post-surgical visits for 37 unique post-operative patients. We now have 42 patients with six-month post-surgery data, showing an average of 20.11 ±4.36% weight loss and a range of 12.5% to 28.1% at the six-month time point.

In 2021, we continued our QI project, Surgery School. As parts of this project, we are revising the bariatric curriculum, piloting five quizzes to test pre-operative knowledge and developing these quizzes in REDCap to pilot an online version.

Promoting Health in Teens and Kids (PHIT Kids) Clinic saw 872 patients in 2171 visits over the last year.

We are in the second year of our National Institutes of Health (NIH) Stay in Treatment study. We were the first site to meet our recruitment goal of 100 patients for cohort one and had the highest retention of these patients (64%) in the study at six months.

We have continued enrollment for the Pediatric Obesity Weight Evaluation Registry (POWER) despite the pandemic. In all our clinics, we have developed a new patient welcome packet, developed teaching on starting medications — including liraglutide — and improved our processes for prior authorization for weight loss medications and surgery.

We have offered biweekly teaching for staff on weight management care through our leadership in the Missouri Telehealth Network’s pediatric weight management ECHO and on use of medications in weight management. Families in all our clinics have also benefitted from the addition of virtual dietitian health coaching in 2021.

We have continued to focus on our three clinical strategic goals: #1 Improve patient outcomes, #2 Improve patient engagement, retention and satisfaction; and #3 Improve staff satisfaction.

The weight management team received an award for the most improved patient satisfaction scores for fiscal year 2021.

We have launched a quality improvement project around Jumpstart, our virtual orientation, to increase show rates at new patient visits. Baseline data indicated a no-show rate of 21.2% for new weight management patients. Jumpstart launched in August 2021 and now new visits have a no-show rate of 9.6%. We are continuing to collect patient satisfaction data and show rate data for this project.

We also had a staff retreat in September and have a monthly virtual lunch bunch to have time together and support each other in and out of clinic.

We continue to develop our data visualizations and database in our joint initiative with the Information Systems Development and Data Analytics teams. We have a dashboard for our pre- and post-surgical patients to assist with tracking patients’ progress and automated weekly reports to track our clinic show rates as part of our Jumpstart QI project. We are now working to populate the Bariatric Surgery QI database with regular automatic uploads. We are near completion of our single weight management dataset, updated monthly or in real time, from which subsets of data can be pulled for different projects. We now have real-time visualizations which show demographic, geographic distributions, BMI’s and other information. These innovations provide real-time opportunities to monitor our patient population characteristics and obtain information needed for grants and QI projects.