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Implementation of Decision Support for the Management of Obesity in a National Pediatric Primary Care Research Network

在国家儿科初级保健研究网络中实施肥胖管理决策支持

基本信息

批准号：
10366093
负责人：
Mahnoosh Sharifi
金额：
$ 76.01万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-08-22 至 2025-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10366093
关键词：
12 year old Address Adolescent Adoption Adult Advisory Committees Affect Attention Award Body mass index Cardiometabolic Disease Cardiovascular Diseases Child Childhood Clinical Informatics Clinical Trials Collection Consolidated Framework for Implementation Research Data Diabetes Mellitus Diagnosis Dissemination and Implementation Educational Materials Effectiveness Effectiveness of Interventions Electronic Health Record Evaluation Geography Group Practice Health Health system Human Hybrids Indiana Intervention Low income Maintenance Malignant Neoplasms Massachusetts Mediating Methods Minority Modeling Obesity Obesity associated cancer Outcome Overweight Parents Patients Pediatric Hospitals Philadelphia Population Prevalence Preventive service Primary Health Care Process Provider Psychology Public Health Qualitative Methods Quality of Care Quality of life Randomized Controlled Trials Reach Effectiveness Adoption Implementation and Maintenance Research Research Design Resources Risk Rural Sampling Site Social Well-Being United States Universities Well in self Work Youth base behavior change care delivery care seeking clinical care clinical decision support contextual factors data de-identification data warehouse demographics disparity reduction effective intervention effectiveness evaluation effectiveness implementation study effectiveness outcome ethnic minority evidence base evidence based guidelines experience formative assessment future implementation high risk implementation efforts implementation evaluation implementation facilitation implementation facilitators implementation intervention implementation outcomes implementation science implementation strategy implementation tool improved minority children models and simulation mortality obesity in children obesity management obesity risk organizational readiness patient population pediatrician practice setting practice-based research network prevent primary care setting racial and ethnic recruit socioeconomics theories therapy design tool trial design uptake urban disparity user centered design

项目摘要

PROJECT SUMMARY/ABSTRACT Nearly 1 in 3 children and adolescents – 23 million youth – in the United States are affected by overweight or obesity, and low-income, racial/ethnic minority and rural children are disproportionately impacted. Beyond the adverse impact of obesity on physical, social, and emotional wellbeing in childhood, children with obesity are at greater risk of obesity in adulthood, placing them at higher risk of obesity-related cancers, cardiometabolic disease, and early mortality. Despite guidance from the US Preventive Services Task Force and expert committees, pediatric primary care clinicians often do not follow available guidance for managing children with obesity. Electronic health records (EHRs) have the potential to improve clinicians' diagnosis and management of obesity by providing tools such as reminders and clinical decision support. We have demonstrated that an intervention package, consisting of EHR-based decision support for pediatricians and educational materials for parents, improved BMI among children in two clinical trials at a multisite group practice in Massachusetts. We have previously estimated, using a simulation model of the U.S. population, that high-fidelity dissemination and implementation of this intervention package among pediatric primary care practices with fully functional EHRs over 10 years has the potential to reach 2 million children with obesity and avert 43,000 cases of obesity at 10 years. However, little is known regarding the effectiveness of the intervention in various pediatric primary care settings, particularly those serving children from populations disproportionately impacted by obesity, or regarding the specific factors that influence the successful adoption and implementation of these tools. In partnership with a national practice-based research network, we aim to capitalize on advances in the field of Implementation Science to apply and evaluate this intervention for childhood obesity among a sample of 84 primary care practices affiliated with three health systems serving children with racial/ethnic, socio-economic, rural-urban, and geographic diversity. The scientific objectives of the proposed award are (1) to optimize a stakeholder-informed intervention and implementation package tailored to site-specific context among a national sample of participating practices, (2) to evaluate the impact of the intervention and implementation facilitation package in improving obesity-related care delivery and children’s BMI, and (3) to rigorously examine what works where and why among participating practice sites. To achieve these aims, we have assembled a transdisciplinary team with expertise is obesity, implementation science, clinical informatics, mixed methods, multi-site interventions, and user-centered design. We will apply a Hybrid Type 2 effectiveness-implementation study design wherein we will employ mixed methods in our formative and summative evaluation plan. To facilitate broad-scale dissemination in future implementation efforts, the results from this proposed study will provide invaluable evidence on the effectiveness of the intervention package and implementation facilitation strategy in settings serving populations most heavily burdened by obesity.

项目总结/摘要在美国，近三分之一的儿童和青少年（2300万青年）受到超重或肥胖的影响。肥胖、低收入、种族/族裔少数和农村儿童受到不成比例的影响。超出肥胖对儿童期身体、社会和情感健康的不利影响，肥胖儿童在成年后肥胖的风险更大，使他们患肥胖相关癌症的风险更高，疾病和早期死亡率。尽管美国预防服务工作组和专家的指导，委员会，儿科初级保健临床医生往往不遵循现有的指导管理儿童与肥胖电子健康记录（EHR）有可能改善临床医生的诊断和管理通过提供诸如提醒和临床决策支持等工具来预防肥胖。我们已经证明，干预包，包括为儿科医生提供的基于EHR的决策支持和在马萨诸塞州的一个多点小组实践中，两项临床试验显示，父母改善了儿童的BMI。我们此前曾估计，使用美国人口的模拟模型，高保真传播和在具有功能齐全的电子病历的儿科初级保健实践中实施该干预包在10年的时间里，有可能接触到200万肥胖儿童，并在10岁时避免43，000例肥胖症年然而，很少有人知道的有效性，干预在各种儿科初级保健环境，特别是那些服务于受肥胖影响不成比例的儿童的环境，影响这些工具成功采用和实施的具体因素。在伙伴关系与作为一个以实践为基础的国家研究网络，我们的目标是利用实施领域的进步在84个初级保健样本中应用和评估这种干预儿童肥胖的科学隶属于三个卫生系统的做法，为种族/民族、社会经济、农村和城市的儿童提供服务地理多样性。该奖项的科学目标是（1）优化知识产权持有人知情在全国抽样调查中，（2）评估干预措施和实施促进一揽子措施在以下方面的影响：改善肥胖相关的护理服务和儿童的BMI，以及（3）严格检查什么在哪里有效，为什么在参与的实践场所。为了实现这些目标，我们组建了一个跨学科的团队，专业知识是肥胖，实施科学，临床信息学，混合方法，多部位干预，以用户为中心的设计我们将采用混合型2有效性-实施研究设计，其中我们将在我们的形成性和总结性评估计划中采用混合方法。促进广泛传播在未来的实施工作中，这项拟议研究的结果将提供宝贵的证据，在为民众服务的环境中一揽子干预措施和执行促进战略的有效性最严重的是肥胖。