Building Evidence for High-Quality Pediatric Primary Care Weight and Comorbidity Management

为高质量儿科初级保健体重和合并症管理建立证据

• 批准号: 9770838
• 负责人: Christy Boling Turer
• 金额: $ 20.25万
• 依托单位: UT SOUTHWESTERN MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-01 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9770838
• 关键词: 12 year old; 18 year old; Academy; Achievement; Address; Adolescent; Adult; Advisory Committees; Age; American; Attention; Behavior Therapy; Blindness; Blood Glucose; Blood Pressure; Body Weight decreased; Body mass index; Caring; Cessation of life; Child; Childhood; Chronic; Clinic; Clinical Decision Support Systems; Clinical Trials; Community Practice; Comorbidity; Cues; Data; Diabetes Mellitus; Diagnosis; Diet; Disease; Electronic Health Record; Elements; Fatty Liver; Goals; Growth; Health; Heart Diseases; Hyperlipidemia; Hypertension; Intervention; Kidney Failure; Laboratories; Lead; Liver Failure; Liver diseases; Medical; Metabolic; Morbid Obesity; National Institute of Diabetes and Digestive and Kidney Diseases; Obesity; Obesity associated disease; Outcome; Overweight; Patients; Pediatrics; Pharmaceutical Preparations; Preventive service; Primary Health Care; Private Practice; Provider; Publishing; Research; Research Priority; Resources; Risk; Risk Factors; Schedule; Stroke; Therapeutic Effect; Toddler; Translating; Visit; Weight; Weight maintenance regimen; cardiometabolic risk; cardiometabolism; care providers; clinical decision support; clinical practice; cohort; electronic data; evidence base; follow-up; healthy weight; improved; lifetime risk; mortality risk; multidisciplinary; novel; nutrition; obesity management; obesity risk; pediatric patients; pediatrician; point of care; premature; programs; routine practice; screening

PROJECT SUMMARY Most providers know that one in three US children is overweight. Fewer recognize that severe obesity is developing earlier, cardiometabolic risk factors are seen even in toddlers, and that obesity-related diseases formerly seen only in adults now are diagnosed in children. These risks are reduced, though, in overweight children who attain a normal weight. During primary-care visits, pediatricians have an opportunity to address weight and weight-management. Although the American Academy of Pediatrics and US Preventive Services Task Force recommend that providers identify overweight/obesity, assess medical risk, and use a staged treatment and reassessment approach, little is known about whether performing these recommended clinical practices in routine practice is associated with improvement in weight or metabolic risk factors. The overall objective of the proposed studies is to identify specific clinical practices and reassessment strategies in primary care that are effective in improving weight status and cardiometabolic risk factors among 2-18 year-old children with overweight and obesity. This will be accomplished through three specific aims, which are to 1) identify whether recommended clinical practices for identifying and managing obesity and related conditions are associated with weight-status improvement in 2-18 year-old children; 2) determine whether these recommended clinical practices impact cardiometabolic risk-factor improvement; and 3) examine the impact of three reassessment strategies—no reassessment, more frequent primary-care visits, or nutrition/comprehensive weight-management program visits—on weight reduction and risk-factor improvement. For all Aims, existing data extracted from electronic health records (EHR) will be analyzed to determine clinical practice elements (such as body-mass-index screening, lab assessments, referrals, and follow-up intervals) associated with improvement in weight status and cardiometabolic risk factors. For Aim 2, laboratory results and blood-pressure values will be used to analyze the association of specific clinical practice elements with cardiometabolic risk-factor improvement. In Aim 3, to examine impact of clinical practices from Aim 1 with three reassessment strategies (no follow-up visits for reassessment, more frequent primary-care visits, or nutrition/comprehensive weight-management-program visits), we will study up to six years of longitudinal data regarding relative weight and risk-factor changes through follow-up visits, referrals to nutrition and comprehensive weight-management programs, and return to routine primary care (upon conclusion of referrals and programs). The proposed studies address how to improve overweight/obesity management in primary care, a research priority of NIDDK. The exceptional resources and institutional support at UT Southwestern, outstanding multi-disciplinary team, and proposed studies will inform primary-care interventions to increase high-quality screening and management of overweight, obesity, and related comorbidities, toward the goal of improved long-term outcomes.

项目摘要 大多数供应商都知道，三分之一的美国儿童超重。很少有人认识到严重的肥胖是 即使在幼儿中也可以看到心脏代谢危险因素， 以前只在成年人中发现，现在被诊断为儿童。然而，这些风险在超重时会降低， 体重正常的儿童。在初级保健访问期间，儿科医生有机会解决 体重和体重管理。尽管美国儿科学会和美国预防服务中心 工作组建议，提供者确定超重/肥胖，评估医疗风险，并使用分阶段 治疗和重新评估的方法，很少有人知道是否执行这些建议的临床 常规实践中的实践与体重或代谢危险因素的改善有关。 拟议研究的总体目标是确定具体的临床实践和重新评估 在初级保健中有效改善体重状况和心脏代谢危险因素的策略 2-18岁的儿童超重和肥胖。这将通过三个具体目标来实现， 其是1）确定是否推荐用于识别和管理肥胖症的临床实践， 相关条件与2-18岁儿童的体重状况改善有关; 2）确定 这些推荐的临床实践是否会影响心脏代谢风险因素的改善;以及3） 检查三种重新评估策略的影响-不重新评估，更频繁的初级保健访问，或 营养/综合体重管理计划访视-体重减轻和风险因素改善。 对于所有目标，将分析从电子健康记录（EHR）中提取的现有数据，以确定临床 实践要素（如体重指数筛查、实验室评估、转诊和随访间隔） 与体重状况和心脏代谢危险因素的改善相关。对于目标2，实验室结果 和血压值将被用来分析特定的临床实践元素与 心脏代谢危险因素改善。在目标3中，检查目标1中临床实践的影响， 重新评估策略（没有重新评估的随访访视，更频繁的初级保健访视，或 营养/综合体重管理计划访问），我们将研究长达六年的纵向数据 关于相对体重和风险因素的变化，通过后续访问，转介营养， 全面的体重管理计划，并返回到常规的初级保健（在转诊结束后 方案）。拟议的研究涉及如何改善小学超重/肥胖管理， 护理，NIDDK的研究优先事项。UT西南大学的特殊资源和机构支持， 杰出的多学科团队，拟议的研究将为初级保健干预提供信息，以增加 对超重、肥胖和相关合并症进行高质量的筛查和管理， 改善长期成果。