Quality standard

Quality statement 3: Referring children and young people for specialist care

Quality statement 3: Referring children and young people for specialist care

Quality statement

Children and young people who are overweight or obese and have significant comorbidities or complex needs are referred to a paediatrician with a special interest in obesity.

Rationale

Children and young people aged under 18 who are overweight or obese are at high risk of significant comorbidities. A paediatrician or GP is likely to identify those comorbidities during an initial assessment and can refer to a paediatrician with a special interest in obesity for investigations and access to tier 3 services.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

Evidence of local arrangements and written protocols to ensure that children and young people who are overweight or obese and have significant comorbidities or complex needs are referred to a paediatrician with a special interest in obesity.

Data source: Evidence can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from service pathways and protocols.

Process

a) Proportion of children and young people who are overweight or obese and have significant comorbidities who are referred to a paediatrician with a special interest in obesity.

Numerator – the number in the denominator who are referred to a paediatrician with a special interest in obesity.

Denominator – the number of children and young people who are overweight or obese and have significant comorbidities.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

b) Proportion of children and young people who are overweight or obese and have complex needs who are referred to a paediatrician with a special interest in obesity.

Numerator – the number in the denominator who are referred to a paediatrician with a special interest in obesity.

Denominator – the number of children and young people who are overweight or obese and have complex needs.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

Outcome

a) Access to tier 3 services for children and young people who are overweight or obese and have significant comorbidities or complex needs.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

b) Weight loss in children and young people who are overweight or obese and have significant comorbidities or complex needs.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

c) Exclusion of underlying medical causes of obesity in children and young people who are overweight or obese.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

d) Treatment of comorbidity in children and young people who are overweight or obese.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

What the quality statement means for different audiences

Service providers (such as primary care, community care and paediatric services) ensure that children and young people who are overweight or obese and have significant comorbidities or complex needs and have been referred to the service have access to a paediatrician with a special interest in obesity.

Healthcare professionals (such as GPs and paediatricians) ensure that they refer children and young people who are overweight or obese and have significant comorbidities or complex needs to a paediatrician with a special interest in obesity.

Commissioners ensure that they commission locally available services that have access to a paediatrician with a special interest in obesity for children and young people who are overweight or obese and have significant comorbidities or complex needs.

Children and young people who are overweight or obese and have another medical condition or a special need such as a learning disability are offered referral to a paediatrician with a special interest in obesity.

Definitions of terms used in this quality statement

BMI centile

Royal College of Paediatrics and Child Health UK-World Health Organization (WHO) growth charts and body mass index (BMI) charts should be used to plot and classify BMI centile. The childhood and puberty close monitoring (CPCM) form can also be used for continued BMI monitoring in children aged 2 and over, especially in instances where puberty is either premature or delayed. Refer to special BMI growth charts for children and young people with Down's syndrome, if needed. [Adapted from NICE's guideline on obesity: identification, assessment and management, recommendation 1.2.21]

Significant comorbidities

These include benign intracranial hypertension, sleep apnoea, obesity hypoventilation syndrome, hyperinsulinaemia, type 2 diabetes, dyslipidaemia, orthopaedic problems and psychological morbidity. Obesity may result from an underlying condition such as an endocrine disease or condition, or may be associated with various syndromes such as Prader–Willi syndrome. [NICE's guideline on weight management: lifestyle services for overweight or obese children and young people, glossary definition of 'complex obesity'; and expert opinion]

Complex needs

These include learning disabilities, chronic illness, physical disability and other additional needs. [NICE's guideline on obesity: identification, assessment and management, recommendation 1.3.10; and expert opinion]