Dissemination and Implementation of an Evidence-Based Pediatric Weight Management Program for Use by Low-Income Families: A User-Friendly Package of Family-Based Behavioral Treatment

传播和实施供低收入家庭使用的循证儿童体重管理计划：用户友好的家庭行为治疗方案

• 批准号: 10516704
• 负责人: Denise Ella Wilfley
• 金额: $ 50万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2024-03-24
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10516704
• 关键词: Dissemination; Implementation; Evidence; Based; Pediatric

Project Summary Family-based Behavioral Treatment (FBT) is an evidence-based pediatric weight management intervention (PWMI) that targets both child and parent. More than 30 years of research indicate that FBT reduces children’s percent overweight by almost 20%, with the average parent losing about 20 pounds during treatment. FBT also meets the US Preventive Services Task Force Recommendations as a comprehensive treatment for childhood obesity delivering more than 26 contact hours. The proposed project brings together a multi-sector team of collaborators, with expertise in behavioral science, community-based implementation science, pediatrics, technology, health services, and health economics. This multi-sector team will package and pilot test FBT for the treatment of pediatric obesity in two sites, representing both rural and urban settings, towards the goal of increasing access to this evidence-based, effective treatment among low-income families with children ages 5 to 12. First, training and treatment will be packaged for dissemination in a turn-key, technology- enhanced format (Aim 1). Given the lack of certified health care providers who can deliver FBT--which creates a major treatment barrier for low-income populations--we will develop the first online FBT training platform that includes FBT training materials for interventionists and treatment support materials for families. To inform this digital treatment package, we will incorporate feedback from a broad range of stakeholders, including representatives from local community-based organizations that serve low-income families, health care providers, local provider organizations, and members of the target populations. Once packaged, the intervention will be implemented in two distinct primary care settings (rural and urban; Aim 2). Primary care offers an optimal setting for FBT delivery, as it capitalizes on the established relationship between primary care providers and families. Co-locating interventionists within the primary care setting overcomes fragmentation of care and addresses provider time and referral barriers. Further, this delivery strategy dovetails with Missouri HealthNet Division’s recent state plan amendment which is scheduled to take effect in Missouri in 2019 to cover intensive obesity behavioral counseling and medical nutrition therapy for Medicaid patients, thus setting the stage for scaling FBT implementation across primary care. Implementation outcomes of the packaged intervention will be assessed at the organizational-level (Aim 2A) and patient-level (Aim 2B). Additionally, a scheduled Medicaid reimbursement mechanism will be evaluated as a promising method for sustainability and can serve as a model for other reimbursement mechanisms for private and public payers across the nation. Finally, the packaged treatment will be optimized based on data and feedback from the study, and community partners will be engaged to develop a sustainability and dissemination plan (Aim 3). Establishing that FBT can be implemented in real world settings is crucial to creating a system where children and their families affected by obesity can be effectively treated in centralized primary care settings.

项目概要 基于家庭的行为治疗 (FBT) 是一种基于证据的儿科体重管理干预措施 （PWMI）针对孩子和父母。 30 多年的研究表明，FBT 可降低儿童的 超重百分比近 20%，治疗期间父母平均减重约 20 磅。也有FBT 符合美国预防服务工作组的建议，作为儿童综合治疗 肥胖导致接触时间超过 26 小时。拟议的项目汇集了一个多部门团队 具有行为科学、社区实施科学、儿科专业知识的合作者， 技术、卫生服务和卫生经济学。这个多部门团队将打包并试点测试 FBT 在代表农村和城市环境的两个地点治疗儿童肥胖，以实现以下目标： 增加有 5 岁儿童的低收入家庭获得这种基于证据的有效治疗的机会 12. 首先，培训和治疗将打包并通过交钥匙技术传播 增强格式（目标 1）。鉴于缺乏能够提供 FBT 的经过认证的医疗保健提供者，这 为低收入人群造成主要治疗障碍——我们将开发首个在线FBT培训 平台，包括针对干预人员的 FBT 培训材料和针对家庭的治疗支持材料。 为了为这个数字化治疗方案提供信息，我们将吸收广泛利益相关者的反馈， 包括为低收入家庭、卫生部门服务的当地社区组织的代表 护理提供者、当地提供者组织和目标人群成员。一旦包装完成， 干预措施将在两个不同的初级保健环境（农村和城市；目标 2）中实施。基本的 护理为 FBT 实施提供了最佳环境，因为它利用了初级保健与初级保健之间已建立的关系。 护理人员和家庭。在初级保健机构内安排干预医生克服了 护理的分散化并解决了提供者的时间和转诊障碍。此外，这种交付策略也符合 密苏里州健康网络部门最近的州计划修正案计划于 2017 年在密苏里州生效 2019 年将为医疗补助患者提供强化肥胖行为咨询和医疗营养治疗，从而 为在初级保健中扩大 FBT 实施奠定基础。实施成果 成套干预措施将在组织层面（目标 2A）和患者层面（目标 2B）。此外，预定的医疗补助报销机制将被评估为一种有前途的方法 可持续发展，并可作为私人和公共付款人其他报销机制的典范 全国各地。最后，将根据数据和反馈优化成套治疗方案 该研究和社区合作伙伴将参与制定可持续性和传播计划 （目标 3）。确定 FBT 可以在现实世界中实施对于创建一个系统至关重要 受肥胖影响的儿童及其家庭可以在集中初级保健机构中得到有效治疗。