Impact of a Primary Care Intervention on Physician Practice and Patient and Family Behavior: Keep ME Healthy-The Maine Youth Overweight Collaborative
Impact of a Primary Care Intervention on Physician Practice and Patient and Family Behavior: Keep ME Healthy-The Maine Youth Overweight Collaborative
复制标题
DOI：
10.1542/peds.2008-2780c
复制
发表时间：
2009-06-01
期刊：
影响因子：
8
通讯作者：
Gortmaker, Steven L.
中科院分区：
文献类型：
--
作者：
Polacsek, Michele;Orr, Joan;Gortmaker, Steven L.
客观的。评估以儿科初级保健为基础的干预措施对改善儿童超重风险行为的临床决策支持和家庭管理的效果。方法。在缅因州城乡地区的 12 个干预点和非随机对照点进行了现场试验。在缅因州青少年超重协作干预之前和期间，通过使用来自 9 个干预中心和 10 个对照地点的临床和家长测量来评估变化。纵向信息收集自对 5-18 岁患者 (n = 600) 的图表审核、干预前 (n = 346) 和干预期间 (n = 386) 在 12 个中心收集的家长系统样本、以及干预期间在 9 个干预中心 (n = 235) 和 10 个对照中心 (n = 304) 收集的家长系统样本。还收集了干预前和干预期间对卫生保健提供者（n = 14 和 17）的调查。团队花了 18 个多月的时间来改进临床决策支持，包括跟踪 BMI 百分位数、识别超重患者、适当的实验室测试、为家庭和患者使用行为筛查工具提供咨询，以及针对 5 至 18 岁患者及其家人的慢性护理模式的其他改进。结果。从缅因州青年超重合作之前到期间，临床实践发生了巨大变化：BMI评估（38%-94%）、年龄和性别BMI百分位（25%-89%）、5-2-1-0行为筛查工具的使用（0%-82%）和体重分类（19%-75%）的增加。家长调查表明提供者的行为和咨询率有所改善。干预提供者报告了知识、态度、自我效能和实践方面的改善。结论。缅因州青少年超重协作干预改善了临床决策支持和风险行为的家庭管理，表明一种有前景的基于初级保健的方法来解决儿童和青少年的超重风险。儿科2009; 123：S258-S266
OBJECTIVE. To evaluate the effect of a pediatric primary care-based intervention, on improved clinical decision support and family management of risk behaviors for childhood overweight.METHODS. An experimental field trial was conducted with 12 intervention sites in urban and rural areas of Maine and nonrandomized control sites. Change was assessed by using clinical and parent measures from 9 intervention and 10 control sites before and during the Maine Youth Overweight Collaborative intervention. Longitudinal information was collected from chart audits of patients aged 5-18 years (n = 600), systematic samples of parents collected before (n = 346) and during (n = 386) the intervention in 12 sites, and systematic samples of parents in 9 intervention (n = 235) and 10 control (n = 304) sites collected during the intervention. Surveys of health care providers (n = 14 and 17) before and during the intervention were also collected. Teams worked over 18 months to implement improvements in clinical decision support, including tracking BMI percentiles, identification of overweight patients, appropriate laboratory tests, counseling of families and patients use of a behavioral screening tool, and other improvements following the chronic-care model targeting patients aged 5 to 18 and their families.RESULTS. Large changes occurred in clinical practice from before to during the Maine Youth Overweight Collaborative: increases in assessment of BMI (38%-94%), BMI percentile for age and gender (25%-89%), use of the 5-2-1-0 behavioral screening tool (0%-82%), and weight classification (19%-75%). Parent surveys indicated improvements in providers' behavior and rates of counseling. Intervention providers reported improvements in knowledge, attitudes, self-efficacy, and practice.CONCLUSIONS. The Maine Youth Overweight Collaborative intervention improved clinical decision support and family management of risk behaviors, indicating a promising primary care-based approach to address overweight risk among children and youth. Pediatrics 2009; 123: S258-S266