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: 10569692
• 负责人: Denise Ella Wilfley
• 金额: $ 30万
• 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 2024-03-24
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10569692
• 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 以家庭为基础的行为治疗（FBT）是一种基于证据的儿科体重管理干预措施 （PWMI），同时针对子级和父级。30多年的研究表明，FBT降低了儿童的 超重率下降了近20%，在治疗期间，平均父母体重减轻了约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 超过26小时的接触时间。拟议的项目汇集了一个多部门的团队， 合作者，在行为科学，基于社区的实施科学，儿科， 技术、卫生服务和卫生经济学。这个多部门团队将对FBT进行包装和试点测试， 在代表农村和城市环境的两个地点治疗儿童肥胖症， 在有5岁儿童的低收入家庭中增加获得这种循证有效治疗的机会 到12.第一，培训和治疗将打包，以一个交钥匙、技术- 增强格式（目标1）。鉴于缺乏经过认证的医疗保健提供者谁可以提供FBT-这 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 该平台包括为干预人员提供的FBT培训材料和为家庭提供的治疗支助材料。 为了告知这个数字治疗包，我们将纳入广泛的利益相关者的反馈， 包括为低收入家庭服务的当地社区组织的代表， 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机构（农村和城市;目标2）实施干预措施。初级 护理为FBT提供了一个最佳的环境，因为它利用了初级保健之间建立的关系， 护理人员和家庭。在初级保健环境中共同定位介入医生克服了 解决了提供者的时间和转诊障碍。此外，这一交付策略是不对称的， 与密苏里州卫生网部门最近的州计划修正案，该修正案计划在密苏里州生效， 2019年将为医疗补助患者提供强化肥胖行为咨询和医学营养治疗， 为在初级保健中扩大FBT的实施奠定了基础。执行成果 将在组织层面（目标2A）和患者层面（目标2B）评估一揽子干预措施 2B）。此外，定期医疗补助报销机制将被评估为一种有前途的方法 可持续性，并可作为私人和公共付款人的其他偿还机制的模式 在全国范围内。最后，将根据数据和来自以下方面的反馈优化成套治疗方案： 该研究和社区合作伙伴将参与制定可持续性和传播计划 (Aim（3）第三章。确定FBT可以在真实的世界环境中实现，对于创建一个系统至关重要， 受肥胖症影响的儿童及其家庭可在中央初级保健机构得到有效治疗。