The Minnesota Department of Health (MDH) and MN Community Measurement (MNCM) released first-time results from two new clinic measures that found most clinics are successfully providing lifestyle counseling to obese children, but less than half are screening adolescents for depression.
When clinicians did screen for depression, they found 9.7 percent – or 4,300 of 43,400 young people screened – had indications of a mental health condition, such as depression, anxiety or attention disorders.
The new data also indicates that 28.6 percent (98,000) of three to 17 year olds who had a well child exam last year were overweight or obese. Of those, 85 percent were counseled about nutrition and physical activity by their provider. This percentage of overweight and obese children in Minnesota clinics is slightly lower than the national rate of 31.8 percent, according to the CDC National Health and Nutrition Examination Survey, which used a different protocol than Minnesota’s effort but was conducted in clinics in 2011-2012 among children 2 to 19 years of age.
“We are excited to have these important new measures of children’s health so we can learn from this information and improve care for Minnesota families,” said Health Commissioner Dr. Ed Ehlinger. These two measures were recently added as part of Minnesota’s quality reporting law that includes 12 clinic measures, eight of which apply to primary care clinics.
This is the first time these measures have been reported in Minnesota. They were developed by MNCM as part of MDH’s Statewide Quality Reporting and Measurement System (SQRMS). MDH partners with MNCM to collect this data and MNCM publicly reports the results.
The Adolescent Mental Health and/or Depression Screening measure evaluates whether patients ages 12 through 17 were screened for mental health conditions during their well child preventive care visits in 2014. The results are reported for 513 clinics in 105 medical groups throughout Minnesota and neighboring communities at Minnesota HealthScores: Mental Health Screening for Teens.
Extreme variation in screening exists across clinics, with some screening none and others screening all of their adolescent patients. Only eight clinics in Minnesota screened 100 percent of their adolescent patients for mental health and/or depression conditions last year.
“It’s really hard, even as a parent, to say what’s the difference between being a normal teenager and a teenager with depression,” said Sue Abderholden, Executive Director of National Alliance on Mental Illness Minnesota. “We always tell families that it’s about length of time and intensity, and that’s why screening is so important. Screening is a thermometer – it can tell you something might be wrong, like when you take your child’s temperature to determine if he or she has a fever.”
Half of all lifetime cases of mental illness begin by age 14, according to the Centers for Disease Control and Prevention.
Untreated depression in adolescence has been tied to an increase in social isolation, academic failure, teenage pregnancy, substance abuse, tobacco use and suicide. MDH’s 2014 Advancing Health Equity in Minnesota report also highlighted that LGBTQ youth are at increased risk of depression and suicide, and University of Minnesota LGBTQ students had significantly higher rates of mental illness than their heterosexual peers.
“The kids who I see with depression or anxiety are really children in pain,” said Dr. Laura Saliterman, a pediatrician and Associate Medical Director at South Lake Pediatrics. “This is different than being sad. If you’re depressed, you’re not going to be doing what you need to in school, in life and you’re not going to be able to handle your physical health.”
The Pediatric Overweight Counseling measure evaluates whether clinics provided nutritional and physical activity counseling to patients ages three through 17 who had a body mass index (BMI) percentile of 85 or above, which indicates a person is overweight or obese. This counseling generally occurred during well child preventive care visits; the measure looked at clinic visits during 2014.
“We want to catch kids at a young enough age where we can change lifestyle and habits, and prevent obesity,” Dr. Saliterman explained. “The earlier you identify these kids, the earlier you can talk to their parents about changes they can make with their kids that are reasonable and will impact their kids’ long term health.”
The results for 458 clinics in 101 medical groups throughout Minnesota and neighboring communities are reported at Minnesota HealthScores: Overweight Counseling for Children. Screening rates vary across clinics; however, 71 clinics provided 100 percent of their overweight pediatric patients with counseling last year.
Obese children are less likely to reach a healthy adult weight, and are at increased risk for chronic conditions including Type 2 Diabetes, hypertension, high cholesterol, asthma, sleep apnea and depression. Additionally, childhood obesity alone is estimated to cost $14 billion annually in direct health expenses.
The goals of the MDH Statewide Quality Reporting and Measurement System are to enhance market transparency by creating a uniform approach to quality measurement, improve health outcomes, and reduce acute care spending.
MN Community Measurement is a non-profit organization dedicated to improving health by publicly reporting health care information. A trusted source of health care data and public reporting on quality, cost and patient experience for more than a decade, MNCM works with varied stakeholders to spur quality improvement, reduce costs and maximize value in health care.