Implementation of Childhood Obesity Treatment Innovations to Improve Outcomes of Low-Income Children: The Connect for Health II Study

项目摘要/摘要 在美国和全世界，心血管疾病是导致死亡和过早死亡的主要原因。 肥胖是心血管疾病的主要诱因，其起源于早期生活。因此，干预措施 减少儿童时期的肥胖和不良风险因素可能会使个人走上最佳的可能轨迹 终身心血管健康。减少儿童肥胖的有希望的方法包括干预 例如Connect for Health，它证明了高度可扩展的多级别干预方案 包括(1)基于电子健康记录(EHR)的临床决策支持工具，以指导儿科临床医生 儿童体重管理；(2)注重循证行为目标的家庭教育材料；以及 (3)向父母发送社交和社区信息以支持行为改变的短信可以改善 儿童肥胖和儿童体重指数(BMI)以家庭为中心的结果。尽管提供了 被证明有效的干预措施，如连接健康，在采用以下技术方面仍然存在重大差距 临床医生和家庭的建议做法，特别是在照顾低收入儿童的环境中。 利用高效医疗信息技术(HIT)的实施战略有助于支持 在临床医生和家庭中采取有效的干预措施。合并HIT可能会特别 如果通过接触父母和儿童来扩大效果，但我们没有足够的证据证明促进者和 采用行为改变建议的障碍以及支持和维持行为的方法 不同患者群体之间的变化。最后，很少有研究试图了解 表现出“积极偏离”的临床医生和家庭，即那些成功执业的医生和家庭 以及在有时不灵活的临床工作流程和/或不利邻居的背景下的行为变化 环境。这项研究的目的是制定和测试实施战略，以加快 在儿科初级医生中接受和采用Connect for Health试验产生的研究证据 关爱团队和家庭。以覆盖范围、有效性、采用、实施、维护(RE- AIM)和实施研究综合框架，我们将使用混合方法来 在马萨诸塞州的两个大型医疗保健系统中调整和实施健康干预连接， 检查与积极偏离相关的可概括和可修改的属性和策略(例如儿童 体重指数在临床上取得显著改善的人和高保真地采用该计划的临床医生)， 并检查与干预相关的成本。为了实现我们的目标，我们组织了一项研究 在肥胖干预、实施科学、信息学、社区方面拥有丰富经验的团队 健康、生物统计学和定性方法。如果成功，这项研究将提供证据证明，成本- 有效、可持续和可推广的策略，以加速采用肥胖筛查证据 在儿科初级保健和改善患有肥胖症的低收入儿童的结局方面的管理。

Project Summary/Abstract Cardiovascular disease is the leading cause of death and premature mortality in the US and worldwide. Obesity is a major contributor to cardiovascular disease and has its origins in early life. Thus, interventions to reduce obesity and adverse risk factors in childhood may set individuals on the best possible trajectories for lifelong cardiovascular health. Promising approaches for reduction of childhood obesity include interventions such as Connect for Health which demonstrated that a highly scalable, multilevel intervention package including (1) electronic health record (EHR)-based clinical decision support tools to guide pediatric clinicians in child weight management; (2) family educational materials focused on evidence-based behavioral targets; and (3) social- and community-informed text messages for parents to support behavior change, could improve family-centered outcomes for childhood obesity and child body mass index (BMI). Despite availability of proven-effective interventions such as Connect for Health, substantial gaps remain in the adoption of recommended practices by clinicians and families, particularly in settings that care for low-income children. Implementation strategies that leverage efficient health information technologies (HIT) can help support adoption of effective interventions among clinicians and families. Incorporation of HIT may be especially effective if augmented by outreach to parents and children, yet we have insufficient evidence on facilitators and barriers to the adoption of behavior change recommendations and ways to support and sustain behavior changes among diverse patient populations. Finally, few studies attempt to learn modifiable attributes of clinicians and families who demonstrate “positive deviance”, i.e. those who have succeeded in making practice and behavior changes in the context of sometimes inflexible clinical workflows and/or adverse neighborhood environments. The purpose of this study is to develop and test implementation strategies to accelerate the uptake and adoption of research evidence generated by the Connect for Health trial among pediatric primary care teams and families. Guided by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE- AIM) and Consolidated Framework for Implementation Research frameworks, we will use mixed-methods to adapt and implement the Connect for Health intervention in two large health care systems in Massachusetts, examine generalizable and modifiable attributes and strategies associated with positive deviance (e.g. children who achieve clinically significant improvements in BMI and clinicians who adopt the program with high fidelity), and examine the costs associated with the intervention. To achieve our aims, we have assembled a research team with extensive experience in obesity interventions, implementation science, informatics, community health, biostatistics, and qualitative methods. If successful, this study will yield evidence of proven, cost- effective, sustainable, and generalizable strategies for accelerating adoption of evidence for obesity screening and management in pediatric primary care and for improving outcomes for low-income children with obesity.