Using Electronic Health Records to Support Decision-Making in Pediatric Obesity Care

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PROJECT SUMMARY/ABSTRACT Despite significant national attention and research, childhood obesity remains a highly prevalent public health threat and contributes to significant short- and long-term adverse health outcomes. Yet, pediatric primary care clinicians often fail to follow available expert guidance for childhood obesity care. Electronic health records (EHRs) have the potential to improve clinicians' diagnosis and treatment of obesity by providing tools such as reminders and clinical decision support. However, little is known regarding the effectiveness of EHR-based decision support systems across health care settings and the specific factors that influence the adoption and impact of these tools. The overall goals of this K08 application are to support Dr. Mahnoosh (Mona) Sharifi attain her career goal of conducting high-impact research on systems-level approaches for facilitating evidence-informed decision making by clinicians, as well as patients and families, to support chronic disease prevention and risk behavior reduction in pediatric primary care. Dr. Sharifi is a child health services researcher, appointed as an Instructor at Harvard Medical School in the Division of General Academic Pediatrics at Massachusetts General Hospital, and a board-certified general pediatrician practicing at the Boston Children's Hospital Primary Care Center. She has drawn on her clinical experience as a pediatrician and her rigorous training in health services research to conduct prior studies demonstrating the potential of EHR-based clinical decision support tools in modifying clinical practice. However, in order to achieve the proposed aims and transition toward an independent research career, she requires the support of this K08 award for additional training in (1) pragmatic clinical trial methods, (2) medical informatics, and (3) dissemination and implementation science. Her training activities will consist of didactic coursework and experiential learning through strong mentorship from national leaders in pediatric obesity research, clinical information systems, quality improvement, and dissemination/implementation science. The scientific objectives of the proposed K08 award will allow Dr. Sharifi to develop critical skills in these key areas by: (1) conducting a cluster randomized controlled trial to assess the comparative effectiveness of two EHR-based tools to support obesity management in pediatric primary care; (2) utilize mixed methods research with surveys and semi- structured qualitative interviews with clinicians in two health systems to examine the contextual impact of the EHR tools on clinician awareness, knowledge and adherence to guidelines and the barriers and facilitators that influence adoption of the tools; and (3) develop a stakeholder-informed Implementation Toolkit to facilitate dissemination and practice-specific implementation of EHR-based tools to support obesity care in pediatric primary. This work is highly responsive to AHRQ research priorities of health information technology (HIT) design, implementation, use and impact on outcomes (NOT-HS-13-011) and the translation, implementation and diffusion of patient-centered, comparative effectiveness research evidence into practice (NOT-HS-13-010).