Expanding the Use of Proven-Effective Pediatric Weight Management Interventions in Community Health Centers

项目摘要 儿童肥胖是发病率和生活质量的沉重负担，也是 重大慢性病。虽然儿童肥胖症在一些美国人中的流行似乎已经停滞不前 自2012年以来，总体比率保持在历史较高水平，种族/族裔和社会经济 差距似乎正在扩大。美国预防服务工作组指南为儿童提供基础 肥胖筛查和管理，但未得到充分利用，不是儿科初级保健常规做法的一部分 护理设置。被证明有效的干预措施，如连接健康和大众运动儿童健康 减肥诊所已经证明，高度可扩展的多层次干预方案包括1)电子 以健康记录(EHR)为基础的临床决策支持工具，指导儿科临床医生进行体重管理； 2)注重循证行为目标的家庭教育材料；3)社会和社区- 向父母发送知情短信，以支持行为改变，以及4)多学科、社区健康 以中心为基础的儿科体重管理门诊，可以改善儿童体重指数(BMI)。虽然 健康连接和运动中的大众儿童健康体重诊所等干预措施已被证明 虽然有效，但在临床医生和家庭采用推荐做法方面仍有很大差距， 特别是在照顾低收入儿童和高水平医疗补助的环境中。疾控中心知晓 行动框架表明，将循证方案转化为例行公事的重要一步 实践正在将科学证据转化为用户友好的干预材料、工具包、战略和 帮助和支持用户将科学付诸实践的信息。这种对基于电子病历的工具的不良采用 部分原因是缺乏对实施者友好的、EHR供应商中立的规范和技术支持 指导融入临床工作流程和流程。虽然许多联邦合格的医疗中心(FQHC) 越来越多地转向基于团队的护理并提供成人慢性病管理 患者的医疗之家，很少有建立以初级保健为基础的健康体重诊所，这种诊所可以显著 提高为大量肥胖儿童提供与体重相关的专门护理的能力。我们的长期合作 目标是改善低收入肥胖儿童的护理和结果。这项工作的主要目标是 建议的研究是打包、实施和评估Connect for Health和 在为低收入儿童服务的儿科初级保健环境中，大规模流动儿童健康体重诊所 有相当高的肥胖率。为了实现我们的目标，我们组织了一项研究， 实施和临床团队，在肥胖干预、实施科学、 临床医生和家庭行为改变、社区健康、研究设计和生物统计学。如果成功，这将是 研究将产生被证明有效的儿科体重管理干预方案，以改善护理 以及低收入肥胖儿童的结果。

Project Summary Childhood obesity represents a substantial burden on morbidity and quality of life and is a major risk factor for major chronic diseases. While childhood obesity prevalence appears to have plateaued in some US population subgroups since 2012, overall rates remain at historically high levels, and racial/ethnic and socioeconomic disparities appear to be widening. US Preventive Service Task Force guidelines provide the basis for childhood obesity screening and management but are underutilized and not part of routine practice in pediatric primary care settings. Proven-effective interventions, such as Connect for Health and the Mass in Motion Kids Healthy Weight Clinic, have demonstrated that a highly scalable, multilevel intervention package including 1) electronic health record (EHR)-based clinical decision support tools to guide pediatric clinicians in weight management; 2) family educational materials focused on evidence-based behavioral targets; 3) social- and community- informed text messages to parents to support behavior change, and 4) multidisciplinary, community health center-based pediatric weight management clinic, could improve child body mass index (BMI). Although interventions such as Connect for Health and Mass in Motion Kids Healthy Weight Clinic have been proven effective, there remains a substantial gap in the adoption of recommended practices by clinicians and families, particularly in settings that care for low-income children with high levels of Medicaid. The CDC's Knowledge to Action framework suggests that an important step in translating evidence-informed programs into routine practice is turning scientific evidence into user-friendly intervention materials, tool kits, strategies, and messages to assist and support users in putting science into practice. This poor adoption of EHR-based tools is due in part to a lack of implementer-friendly, EHR vendor-neutral specifications and technical support to guide integration into clinical workflows and processes. While many federally qualified health centers (FQHCs) are increasingly moving towards team-based care and delivering adult chronic disease management in the patient's medical home, few have established primary care based healthy weight clinics that can dramatically increase capacity for specialized, weight-related care for large numbers of children with obesity. Our long-term goal is to improve the care and outcomes of low-income children with obesity. The primary objectives of this proposed study are to package, implement and evaluate the evidence generated by Connect for Health and the Mass in Motion Kids Healthy Weight Clinic in pediatric primary care settings serving low-income children with a substantially high prevalence of obesity. To achieve our aims, we have assembled a research, implementation, and clinical team with extensive experience in obesity interventions, implementation science, clinician and family behavior change, community health, research design and biostatistics. If successful, this study will yield a proven effective, pediatric weight management intervention package for improving the care and outcomes for low-income children with obesity.