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

点击翻译按钮获取中文摘要

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.