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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

基本信息

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
项目类别：
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

项目摘要

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.

项目总结