Clinical-Community Approaches to Pediatric Weight Management: MA CORD 2.0

项目摘要 尽管最近在预防肥胖方面取得了进展，但美国超重和肥胖的流行率仍保持在 历史上的高水平以及种族/族裔和社会经济差距依然存在。许多因素导致了 肥胖的难治性，但有希望的预防和减少方法正在出现，包括多种 在儿童消磨时间的环境中，各部门采取协作干预措施。我们的研究人员 马萨诸塞州公共卫生部(MDPH)和马萨诸塞州综合医院的团队 一直处于儿童肥胖预防和管理创新的前沿，使用临床， 社区和环境方法。我们现在寻求在这些创新战略的基础上，具体地 优化对低收入儿童的护理，体重指数(BMI)为≥第85个百分位数，其中 要实现BMI的改善，需要更多的能源赤字，而不是 仅有社区和环境方法。为了实现这一目标，我们提出了一个新的临床社区。 干预措施，理论上以综合临床和社区护理系统模式为基础，以 通过优化筛查和管理来解决肥胖问题，这在STAR试验中是有效的，e- 由马萨诸塞州儿童肥胖症健康体重诊所测试的MDPH开发的转介 研究示范项目，以及基督教青年会的健康体重和您的儿童体重管理 程序(最初称为修补程序)。我们将致力于实施高质量的护理模式，以解决 6-12岁儿童的超重和肥胖，包括：(A)计算机化的护理地点决定 支持初级保健提供者改进肥胖筛查和咨询；(B)教育材料和 用于自我引导行为改变支持的交互式文本消息；(C)指向社区资源的链接以支持 行为改变；和(D)基于EHR转诊的结构化儿科体重管理。在嵌套的、 我们还将检验儿科体重管理的比较效果 在健康体重诊所提供的计划与基督教青年会的健康体重和您的孩子计划进行比较。我们的 这项研究将检查对包括父母在内的广泛利益相关者群体最重要的儿童的结果， 临床医生和公共卫生从业者，以及为700万超重或肥胖儿童的护理提供信息 儿童健康保险计划或医疗补助计划涵盖的肥胖。为了达到这些目标，我们有 组建了一支在实施和评估范式方面拥有广泛专业知识的多学科团队- 轮班、临床和社区体重管理方案以及健康信息的使用 将临床交付系统与社区资源连接起来以改善健康结果的技术。 与Medicaid的合作将确保该计划的可持续性，如果成功，可能会提供 新的肥胖模式照顾到了最需要它的那部分人。

Project Summary Despite recent progress in obesity prevention, the prevalence of overweight and obesity in the US remains at historically high levels and racial/ethnic and socioeconomic disparities persist. Many factors contribute to the intractability of obesity but promising approaches for prevention and reduction are emerging including multi- sector, collaborative interventions across settings where children spend their time. Members of our research team at the Massachusetts Department of Public Health (MDPH) and the Massachusetts General Hospital have been at the forefront of innovation in childhood obesity prevention and management using clinical, community, and environmental approaches. We now seek to build on these innovative strategies to specifically optimize the care of low-income children with a body mass index (BMI) ≥ 85th percentile and in whom far greater energy deficits will be necessary to achieve improvements in BMI than those that can be achieved with community and environmental approaches alone. To achieve this goal, we propose a new clinical-community intervention, theoretically grounded in the Integrated Clinical and Community Systems of Care Model, to address obesity through optimized screening and management known to be effective in the STAR trial, e- Referrals developed by MDPH, Healthy Weight Clinics tested in the Massachusetts Childhood Obesity Research Demonstration project, and the YMCA's Healthy Weight and Your Child weight management program (originally known as MEND). We will aim to implement a model of high quality care for addressing overweight and obesity among 6-12 year old children that includes (a) computerized point-of-care decision supports to primary care providers to improve obesity screening and counseling; (b) educational materials and interactive text messages for self-guided behavior change support; (c) links to community resources to support behavior change; and (d) EHR-referral based, structured pediatric weight management. In a nested, randomized controlled trial we will also examine the comparative effects of a pediatric weight management program delivered in a Healthy Weight Clinic vs. the YMCA's Healthy Weight and Your Child program. Our study will examine outcomes for children that matter most to a broad group of stakeholders including parents, clinicians, and public health practitioners as well as inform the care of >7 million children with overweight or obesity covered by the Children's Health Insurance Program or Medicaid. To achieve these aims, we have assembled a multidisciplinary team with extensive expertise in implementation and evaluation of paradigm- shifting, clinical and community weight management programs as well as the use of health information technology to connect clinical delivery systems with community resources to improve health outcomes. Collaboration with Medicaid will ensure the sustainability of the program, which if successful, may provide a new model of obesity care for the very segment of the population who need it most.