Accelerating Adoption of Childhood Obesity Comparative Effectiveness Research

描述(由申请人提供)：儿童肥胖症非常普遍，并与短期和长期的不良后果有关。认识到儿童肥胖对公众健康的重要性，美国医学会、卫生资源和服务管理局以及疾病控制和预防中心于2007年发布了专家委员会关于评估、预防和治疗儿童和青少年超重和肥胖的建议，这是对1998年发布的指南的修订。2009年，国家质量保证委员会发布了新的国家标准绩效衡量标准(健康计划和雇主数据和信息集[HEDIS])，重点是提高儿童肥胖症的护理质量。最近一次是在2010年，美国预防服务工作组建议对年仅6岁的儿童和青少年进行肥胖症筛查，进一步强调了这一临床和公共卫生问题的广泛重要性。尽管已有近十年的指导方针和较新的比较有效性研究(CER)证据，但卫生保健系统采用推荐做法的速度一直很慢。尽管儿科保健提供者经常提到时间、技能和资源有限等障碍，但一个经常被忽视的障碍是缺乏数据系统来有效和准确地评估指南的实施情况，并提高儿童肥胖症的护理质量。健康信息技术(HIT)为加快采用CER关于儿童肥胖筛查和管理的证据、建立治疗基准以及支持患者及其临床团队改善护理提供了潜力。如果通过扩大对父母和儿童的宣传，纳入HIT可能特别有效。这项研究的目的是在一项整群随机对照试验中开发和测试两种采用儿童肥胖CER证据的系统策略。第一种是在常规办公室访问期间向儿科初级保健提供者提供计算机化的护理点决策警报，与基于CER的护理算法相联系。第二种方法是通过直接与父母沟通儿童的体重指数(BMI)以及推荐的评估和管理来加强这种HIT方法。目标人群是6至12岁的儿童，体重指数e 95百分位数。结果措施将包括1)证明遵守基于CER的筛查指南的护理点措施，2)登记后1年的BMI和肥胖相关行为，以及3)每个干预部门的成本和成本效益。我们还将制定一份详细的传播指南，以进一步加快CER关于儿童肥胖的证据在有兴趣实施类似干预措施的实践和社区中的采用。为了实现我们的目标，我们组建了一支研究团队，在肥胖预防、临床医生和儿童行为变化、临床信息学、集群随机对照试验的统计方法、成本效益分析和传播科学方面拥有丰富的经验。如果成功，该项目将提供新的和可持续的方法，以加快采用CER证据进行儿童肥胖症筛查和管理，并在儿科初级保健中提高儿童肥胖症的护理质量。 与公共卫生相关：儿童肥胖症很普遍，而且很严重。尽管有比较有效性研究(CER)的证据，但卫生保健系统在采用管理儿童肥胖症的推荐做法方面进展缓慢。这项研究的目标是开发和测试系统级干预措施，以加快采用CER证据进行儿童肥胖症筛查和管理，并最终改善私营和公共部门与肥胖症相关的医疗质量和结果。

DESCRIPTION (provided by applicant): Childhood obesity is highly prevalent and is associated with both short- and long-term adverse outcomes. In recognition of the public health importance of childhood obesity, the American Medical Association, the Health Resources and Services Administration, and the Centers for Disease Control and Prevention released Expert Committee Recommendations on the Assessment, Prevention, and Treatment of Child and Adolescent Overweight and Obesity in 2007, a revision of guidelines originally issued in 1998. In 2009, the National Committee for Quality Assurance released new nationally standardized performance measures (Health Plan and Employer Data and Information Set [HEDIS]), focused on improving quality of care for obesity in children. Most recently in 2010, The United States Preventive Service Task Force recommended screening for obesity in children and adolescents as young as 6 years of age, further highlighting the wide-reaching importance of this clinical and public health issue. Despite availability of guidelines for nearly a decade and more recent comparative effectiveness research (CER) evidence, the health care system has been slow to adopt recommended practices. Although pediatric health care providers often cite barriers such as limited time, skill, and resources, a frequently overlooked barrier is the lack of data systems to efficiently and accurately assess guideline implementation and to improve quality of care for childhood obesity. Health information technology (HIT) offers potential for accelerating the adoption of CER evidence regarding childhood obesity screening and management, for establishing treatment benchmarks, and for supporting patients and their clinical teams in care improvement. Incorporation of HIT may be especially effective if augmented by outreach to parents and children. The purpose of this study is to develop and test, in a cluster-randomized controlled trial, two systematic strategies for adoption of childhood obesity CER evidence. The first incorporates computerized point-of-care decision alerts to pediatric primary care providers during routine office visits, linked to CER-based algorithms of care. The second augments this HIT approach with direct-to-parent communication of child's body mass index (BMI) along with recommended evaluation and management. The target population is children ages 6 to 12 years with a BMI e 95th percentile. Outcome measures will include 1) point-of-care measures demonstrating adherence to CER-based screening guidelines, 2) BMI and obesity-related behaviors at 1-year post enrollment, and 3) cost and cost effectiveness of each intervention arm. We will also develop a detailed dissemination guide to further accelerate adoption of CER evidence on childhood obesity in practices and communities interested in implementing similar interventions. To achieve our aims, we have assembled a research team with extensive experience in obesity prevention, clinician and child behavior change, clinical informatics, statistical methodology in cluster randomized controlled trials, cost-effectiveness analyses, and dissemination science. If successful, this project will provide new and sustainable approaches for accelerating adoption of CER evidence for childhood obesity screening and management and for improving quality of care for childhood obesity in pediatric primary care. PUBLIC HEALTH RELEVANCE: Childhood obesity is prevalent and of consequence. Despite availability of comparative effectiveness research (CER) evidence, the health care system has been slow to adopt recommended practices for management of childhood obesity. The goal of this study is to develop and test system-level interventions to accelerate the adoption of CER evidence on childhood obesity screening and management and ultimately improve obesity- related health care quality and outcomes in the private and public sector.