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

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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.