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: 10569127
• 负责人: Lauren Gehler Fiechtner
• 金额: $ 30.7万
• 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/10569127
• 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.

项目摘要 儿童肥胖症对发病率和生活质量造成了巨大负担，是儿童肥胖症的主要危险因素。 重大慢性病。虽然儿童肥胖症的患病率在一些美国人口中似乎已经趋于稳定， 自2012年以来，总体发病率保持在历史高位，种族/民族和社会经济 差距似乎在扩大。美国预防服务工作组的指导方针提供了基础的童年 肥胖筛查和管理，但未得到充分利用，也不是儿科初级保健常规实践的一部分。 护理设置。经证明有效的干预措施，如“连接健康”和“群众运动儿童健康” 体重诊所，已经证明，一个高度可扩展的，多层次的干预包，包括1）电子 基于健康记录（EHR）的临床决策支持工具，用于指导儿科临床医生进行体重管理; 2)注重循证行为目标的家庭教育材料; 3）社会和社区- 向父母发送知情短信，以支持行为改变，以及4）多学科，社区健康 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 “健康连接”和“运动中的大众儿童健康体重诊所”等干预措施已得到证实 有效，在临床医生和家庭采用推荐做法方面仍然存在很大差距， 特别是在照顾低收入儿童和高水平医疗补助的环境中。CDC的知识 行动框架表明，将循证方案转化为常规方案的重要一步 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， 信息，以协助和支持用户将科学付诸实践。这种对基于EHR的工具的不良采用 部分原因是缺乏对实现者友好的、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过程中。虽然许多联邦合格的健康中心（CADHCs） 越来越多地转向以团队为基础的护理， 病人的医疗之家，很少有建立初级保健为基础的健康体重诊所，可以显着 提高为大量肥胖儿童提供与体重有关的专门护理的能力。我们的长期 目标是改善低收入肥胖儿童的护理和结果。本项目的主要目标 拟议的研究是包装，实施和评估连接健康产生的证据， 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 肥胖症的患病率相当高。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改变，社区卫生，研究设计和生物统计学。如果成功，这 研究将产生一个有效的，儿科体重管理干预包，以改善护理 和低收入儿童肥胖的结果。