Dissemination and Implementation of an Evidence-Based Pediatric Weight Management Program for Use by Low-Income Families: A User-Friendly Package of Family-Based Behavioral Treatment

传播和实施供低收入家庭使用的循证儿童体重管理计划：用户友好的家庭行为治疗方案

• 批准号: 9812540
• 负责人: Denise Ella Wilfley
• 金额: $ 74.93万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9812540
• 关键词: Dissemination; Implementation; Evidence; Based; Pediatric

Project Summary Family-based Behavioral Treatment (FBT) is an evidence-based pediatric weight management intervention (PWMI) that targets both child and parent. More than 30 years of research indicate that FBT reduces children’s percent overweight by almost 20%, with the average parent losing about 20 pounds during treatment. FBT also meets the US Preventive Services Task Force Recommendations as a comprehensive treatment for childhood obesity delivering more than 26 contact hours. The proposed project brings together a multi-sector team of collaborators, with expertise in behavioral science, community-based implementation science, pediatrics, technology, health services, and health economics. This multi-sector team will package and pilot test FBT for the treatment of pediatric obesity in two sites, representing both rural and urban settings, towards the goal of increasing access to this evidence-based, effective treatment among low-income families with children ages 5 to 12. First, training and treatment will be packaged for dissemination in a turn-key, technology- enhanced format (Aim 1). Given the lack of certified health care providers who can deliver FBT--which creates a major treatment barrier for low-income populations--we will develop the first online FBT training platform that includes FBT training materials for interventionists and treatment support materials for families. To inform this digital treatment package, we will incorporate feedback from a broad range of stakeholders, including representatives from local community-based organizations that serve low-income families, health care providers, local provider organizations, and members of the target populations. Once packaged, the intervention will be implemented in two distinct primary care settings (rural and urban; Aim 2). Primary care offers an optimal setting for FBT delivery, as it capitalizes on the established relationship between primary care providers and families. Co-locating interventionists within the primary care setting overcomes fragmentation of care and addresses provider time and referral barriers. Further, this delivery strategy dovetails with Missouri HealthNet Division’s recent state plan amendment which is scheduled to take effect in Missouri in 2019 to cover intensive obesity behavioral counseling and medical nutrition therapy for Medicaid patients, thus setting the stage for scaling FBT implementation across primary care. Implementation outcomes of the packaged intervention will be assessed at the organizational-level (Aim 2A) and patient-level (Aim 2B). Additionally, a scheduled Medicaid reimbursement mechanism will be evaluated as a promising method for sustainability and can serve as a model for other reimbursement mechanisms for private and public payers across the nation. Finally, the packaged treatment will be optimized based on data and feedback from the study, and community partners will be engaged to develop a sustainability and dissemination plan (Aim 3). Establishing that FBT can be implemented in real world settings is crucial to creating a system where children and their families affected by obesity can be effectively treated in centralized primary care settings.

项目摘要 基于家庭的行为治疗(FBT)是一种循证的儿童体重管理干预措施 (PWMI)，它同时对象子对象和父对象。30多年的研究表明，FBT会降低儿童的 体重超重近20%，父母在治疗期间平均减掉约20磅。FBT也 符合美国预防服务工作组的建议，作为儿童的综合治疗 肥胖带来的接触时间超过26个小时。拟议的项目汇集了一个由多个部门组成的团队 合作者，在行为科学、社区实施科学、儿科学、 技术、医疗服务和医疗经济。这个多部门团队将打包并试点测试FBT 在两个地点治疗儿童肥胖症，分别代表农村和城市环境，以实现 增加有5岁孩子的低收入家庭获得这种以证据为基础的有效治疗的机会 首先，培训和治疗将打包在交钥匙中传播，技术- 增强格式(目标1)。鉴于缺乏能够提供FBT的有资质的医疗保健提供者-- 为低收入人群创造了一个主要的治疗障碍--我们将开发第一个在线FBT培训 该平台包括针对干预者的FBT培训材料和针对家庭的治疗支持材料。 为了向这个数字治疗方案提供信息，我们将纳入来自广泛利益相关者的反馈， 包括当地社区组织的代表，这些组织服务于低收入家庭、健康 护理提供者、当地提供者组织和目标人群的成员。一旦打包， 将在两个不同的初级保健环境(农村和城市；目标2)实施干预措施。主要 CARE为FBT分娩提供了最佳环境，因为它利用了初级保健之间建立的关系 护理提供者和家庭。在初级保健环境中共同安置干预者克服了 护理的碎片化，解决了提供者的时间和转诊障碍。此外，这一交付战略与 密苏里州医疗网络部门最近的州计划修正案计划于#年在密苏里州生效 2019年覆盖密集肥胖行为咨询和医疗补助患者的医疗营养治疗，因此 为在初级保健中推广FBT实施奠定了基础。《公约》实施成果 一揽子干预措施将在组织层面(目标2A)和患者层面(目标)进行评估 2B)。此外，预定的医疗补助报销机制将被评估为一种有前景的方法 可持续发展，并可作为私营和公共支付者其他补偿机制的典范 在全国范围内。最后，将根据数据和来自以下方面的反馈来优化打包治疗 这项研究和社区伙伴将参与制定可持续发展和传播计划 (目标3)。建立可以在现实世界环境中实施的FBT对于创建一个 受肥胖症影响的儿童及其家人可以在中央初级保健环境中得到有效治疗。