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Implementation of Decision Support for the Management of Obesity in a National Pediatric Primary Care Research Network

在国家儿科初级保健研究网络中实施肥胖管理决策支持

基本信息

批准号：
10678630
负责人：
Mahnoosh Sharifi
金额：
$ 73.75万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-08-22 至 2025-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10678630
关键词：
12 year old Address Adolescent Adoption Adult Affect Attention Award Body mass index Cardiometabolic Disease Cardiovascular Diseases Child Childhood Clinical Informatics Clinical Trials Collection Consolidated Framework for Implementation Research Data Diabetes Mellitus Diagnosis Disparity Disparity population Dissemination and Implementation Educational Materials Effectiveness Effectiveness of Interventions Electronic Health Record Ethnic Origin Evaluation Geography Group Practice Health Health system Human Hybrids Indiana Intervention Low income Maintenance Malignant Neoplasms Massachusetts Mediating Methods Minority Modeling Obesity Obesity associated cancer Outcome Overweight Parents Patients Pediatric Hospitals Philadelphia Population Prevalence Primary Care Process Provider Psychology Public Health Qualitative Methods Quality of Care Quality of life Race Randomized, Controlled Trials Reach, Effectiveness, Adoption, Implementation, and Maintenance Recommendation Research Research Design Resources Risk Rural Sampling Site United States United States Preventative Services Task Force Universities Well in self Work Youth behavior change care delivery clinical care clinical decision support contextual factors data de-identification data warehouse demographics disparity reduction effective intervention effectiveness evaluation effectiveness outcome effectiveness/implementation study ethnic minority evidence base evidence based guidelines experience formative assessment future implementation high risk implementation efforts implementation evaluation implementation facilitation implementation facilitators implementation intervention implementation outcomes implementation science implementation strategy implementation tool improved minority children models and simulation mortality obesity in children obesity management obesity risk organizational readiness patient population pediatrician practice setting practice-based research network prevent primary care clinician primary care practice primary care setting racial minority recruit social socioeconomics theories tool trial design uptake urban disparity user centered design

项目摘要

PROJECT SUMMARY/ABSTRACT Nearly 1 in 3 children and adolescents – 23 million youth – in the United States are affected by overweight or obesity, and low-income, racial/ethnic minority and rural children are disproportionately impacted. Beyond the adverse impact of obesity on physical, social, and emotional wellbeing in childhood, children with obesity are at greater risk of obesity in adulthood, placing them at higher risk of obesity-related cancers, cardiometabolic disease, and early mortality. Despite guidance from the US Preventive Services Task Force and expert committees, pediatric primary care clinicians often do not follow available guidance for managing children with obesity. Electronic health records (EHRs) have the potential to improve clinicians' diagnosis and management of obesity by providing tools such as reminders and clinical decision support. We have demonstrated that an intervention package, consisting of EHR-based decision support for pediatricians and educational materials for parents, improved BMI among children in two clinical trials at a multisite group practice in Massachusetts. We have previously estimated, using a simulation model of the U.S. population, that high-fidelity dissemination and implementation of this intervention package among pediatric primary care practices with fully functional EHRs over 10 years has the potential to reach 2 million children with obesity and avert 43,000 cases of obesity at 10 years. However, little is known regarding the effectiveness of the intervention in various pediatric primary care settings, particularly those serving children from populations disproportionately impacted by obesity, or regarding the specific factors that influence the successful adoption and implementation of these tools. In partnership with a national practice-based research network, we aim to capitalize on advances in the field of Implementation Science to apply and evaluate this intervention for childhood obesity among a sample of 84 primary care practices affiliated with three health systems serving children with racial/ethnic, socio-economic, rural-urban, and geographic diversity. The scientific objectives of the proposed award are (1) to optimize a stakeholder-informed intervention and implementation package tailored to site-specific context among a national sample of participating practices, (2) to evaluate the impact of the intervention and implementation facilitation package in improving obesity-related care delivery and children’s BMI, and (3) to rigorously examine what works where and why among participating practice sites. To achieve these aims, we have assembled a transdisciplinary team with expertise is obesity, implementation science, clinical informatics, mixed methods, multi-site interventions, and user-centered design. We will apply a Hybrid Type 2 effectiveness-implementation study design wherein we will employ mixed methods in our formative and summative evaluation plan. To facilitate broad-scale dissemination in future implementation efforts, the results from this proposed study will provide invaluable evidence on the effectiveness of the intervention package and implementation facilitation strategy in settings serving populations most heavily burdened by obesity.

项目总结/文摘