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

项目总结/摘要 心血管疾病是美国和世界范围内死亡和过早死亡的主要原因。 肥胖是心血管疾病的一个主要因素，其起源于早期生活。因此， 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发展轨道， 终身心血管健康减少儿童肥胖的有希望的方法包括干预措施 例如“健康连接”，它证明了一个高度可扩展的多层次干预方案， 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 （2）注重循证行为目标的家庭教育材料;以及 (3)向父母提供社会和社区信息的短信，以支持行为改变， 以家庭为中心的儿童肥胖和儿童体重指数（BMI）的结果。尽管有 尽管“连接健康”等经证明有效的干预措施，但在采用 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。 利用高效的卫生信息技术（HIT）的实施战略可以帮助支持 在临床医生和家庭中采取有效的干预措施。加入HIT可能特别重要， 有效的，如果扩大了对父母和儿童的宣传，但我们没有足够的证据， 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，很少有研究试图学习 表现出“积极偏差”的临床医生和家庭，即那些成功实践的人 以及在有时不灵活的临床工作流程和/或不利的邻居的背景下的行为变化 环境.本研究的目的是制定和测试实施战略，以加快 吸收和采用Connect for Health试验在儿科初级 护理团队和家庭。以达到，有效性，采用，实施，维护（RE- AIM）和实施研究综合框架框架，我们将使用混合方法， 在马萨诸塞州的两个大型医疗保健系统中调整和实施“连接健康”干预措施， 检查与积极偏差相关的可推广和可修改的属性和策略（例如，儿童 在BMI方面取得临床显著改善的人和采用高保真程序的临床医生）， 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， 团队在肥胖干预、实施科学、信息学、社区 卫生、生物统计和定性方法。如果成功，这项研究将产生证据证明，成本- 有效的，可持续的，可推广的策略，以加速肥胖筛查证据的采用 和儿科初级保健的管理，并改善低收入肥胖儿童的结果。

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.