Expanding the Use of Proven-Effective Pediatric Weight Management Interventions in Community Health Centers

在社区卫生中心扩大使用行之有效的儿童体重管理干预措施

• 批准号: 9812578
• 负责人: Elsie Mireya Taveras Benavidez
• 金额: $ 75万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 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/9812578
• 关键词: Expanding; Use; Proven; Effective; Pediatric

Project Summary Childhood obesity represents a substantial burden on morbidity and quality of life and is a major risk factor for major chronic diseases. While childhood obesity prevalence appears to have plateaued in some US population subgroups since 2012, overall rates remain at historically high levels, and racial/ethnic and socioeconomic disparities appear to be widening. US Preventive Service Task Force guidelines provide the basis for childhood obesity screening and management but are underutilized and not part of routine practice in pediatric primary care settings. Proven-effective interventions, such as Connect for Health and the Mass in Motion Kids Healthy Weight Clinic, have demonstrated that a highly scalable, multilevel intervention package including 1) electronic health record (EHR)-based clinical decision support tools to guide pediatric clinicians in weight management; 2) family educational materials focused on evidence-based behavioral targets; 3) social- and community- informed text messages to parents to support behavior change, and 4) multidisciplinary, community health center-based pediatric weight management clinic, could improve child body mass index (BMI). Although interventions such as Connect for Health and Mass in Motion Kids Healthy Weight Clinic have been proven effective, there remains a substantial gap in the adoption of recommended practices by clinicians and families, particularly in settings that care for low-income children with high levels of Medicaid. The CDC's Knowledge to Action framework suggests that an important step in translating evidence-informed programs into routine practice is turning scientific evidence into user-friendly intervention materials, tool kits, strategies, and messages to assist and support users in putting science into practice. This poor adoption of EHR-based tools is due in part to a lack of implementer-friendly, EHR vendor-neutral specifications and technical support to guide integration into clinical workflows and processes. While many federally qualified health centers (FQHCs) are increasingly moving towards team-based care and delivering adult chronic disease management in the patient's medical home, few have established primary care based healthy weight clinics that can dramatically increase capacity for specialized, weight-related care for large numbers of children with obesity. Our long-term goal is to improve the care and outcomes of low-income children with obesity. The primary objectives of this proposed study are to package, implement and evaluate the evidence generated by Connect for Health and the Mass in Motion Kids Healthy Weight Clinic in pediatric primary care settings serving low-income children with a substantially high prevalence of obesity. To achieve our aims, we have assembled a research, implementation, and clinical team with extensive experience in obesity interventions, implementation science, clinician and family behavior change, community health, research design and biostatistics. If successful, this study will yield a proven effective, pediatric weight management intervention package for improving the care and outcomes for low-income children with obesity.

项目概要 儿童肥胖对发病率和生活质量造成沉重负担，并且是儿童肥胖的主要危险因素。 主要慢性病。虽然美国部分人群的儿童肥胖患病率似乎已趋于稳定 自 2012 年以来，各亚群体的总体比率仍处于历史高位，种族/族裔和社会经济 差距似乎正在扩大。美国预防服务工作组指南为儿童时期提供了基础 肥胖筛查和管理，但未得到充分利用，并且不是儿科小学常规实践的一部分 护理设置。行之有效的干预措施，例如 Connect for Health 和 Mass in Motion Kids Healthy Weight Clinic 已证明，高度可扩展的多层次干预方案包括 1) 电子 基于健康记录（EHR）的临床决策支持工具，指导儿科临床医生进行体重管理； 2) 家庭教育材料侧重于基于证据的行为目标； 3) 社会-和社区- 向家长发送知情短信以支持行为改变，以及 4) 多学科、社区健康 以中心为基础的儿科体重管理诊所，可以改善儿童体重指数（BMI）。虽然 Connect for Health 和 Mass in Motion Kids Healthy Weight Clinic 等干预措施已得到证实 有效，但临床医生和家庭在采用建议的做法方面仍然存在很大差距， 特别是在照顾低收入儿童并享受高额医疗补助的环境中。 CDC 的知识 行动框架表明，将循证计划转化为常规的重要一步 实践正在将科学证据转化为用户友好的干预材料、工具包、策略和 帮助和支持用户将科学付诸实践的消息。基于 EHR 的工具采用率不高 部分原因是缺乏实施者友好、EHR 供应商中立的规范和技术支持 指导整合到临床工作流程和流程中。虽然许多联邦合格的健康中心 (FQHC) 越来越多地转向基于团队的护理并在以下地区提供成人慢性病管理 在患者的医疗之家，很少有人建立以初级保健为基础的健康体重诊所，这些诊所可以显着 提高对大量肥胖儿童进行专门的、与体重相关的护理的能力。我们的长期 目标是改善低收入肥胖儿童的护理和结果。本次活动的主要目标 拟议的研究旨在打包、实施和评估 Connect for Health 产生的证据以及 Mass in Motion 儿童健康体重诊所位于儿科初级保健机构，为低收入儿童提供服务 肥胖患病率相当高。为了实现我们的目标，我们进行了一项研究， 实施和临床团队在肥胖干预、实施科学、 临床医生和家庭行为变化、社区健康、研究设计和生物统计学。如果成功的话，这 研究将产生一个行之有效的儿科体重管理干预方案，以改善护理 以及低收入肥胖儿童的结果。