Primary Care, Communication, & Improving Children's Health

描述(申请人提供)：在美国，儿童超重是一个重要的公共卫生问题。目前的估计表明，每三个孩子中就有一个超重。超过一半的超重5-10岁儿童至少有一种心血管疾病风险因素，超重会增加心血管疾病和过早死亡的终生风险，但在体重正常的超重儿童中，这些风险会降低。在健康儿童就诊期间，儿科医生有机会解决体重和体重管理问题。然而，与超重儿童体重改善相关的临床实践要素和儿科医生与患者沟通策略知之甚少。拟议项目的总体目标是确定在健康儿童就诊期间预测超重儿童相对体重改善的具体临床实践要素和儿科医生与患者沟通策略。这将通过三个具体目标来实现，即1)确定儿科初级保健中预测体重状况改善的具体临床实践要素；2)确定预测体重状况改善的沟通策略；以及3)开发和测试试点干预措施的可行性和可接受性，以改善儿科医生在与超重儿童进行初级保健期间解决体重和体重管理问题时的具体临床实践要素的沟通和使用。对于目标1，将对电子病历(EMR)进行分析，以确定与一年后体重状况改善相关的临床实践要素(如实验室评估和随访间隔)。对于目标2，将使用视频记录的健康儿童访问的Roter交互分析来分析儿科医生与患者关于体重和体重管理的沟通(包括关于超重状况的评估和咨询，以及沟通动态，包括以患者为中心)，并将通过一年多的EMR跟踪儿童的间隔访问、体重/身高和转介。目标1和目标2的结果将用于目标3，以开发和测试试点干预的可行性和可接受性。 旨在提高儿科医生在初级保健就诊期间使用特定临床实践要素和有效沟通方面的观察和自我报告能力，与标准实践的对照组相比。拟议的职业发展奖旨在解决如何改善初级保健中的超重/肥胖管理，这是NHLBI工作组召开的一个研究重点，目的是确定未来儿童肥胖症预防和治疗的研究重点。得克萨斯大学西南分校的特殊资源和机构支持、出色的多学科指导团队以及拟议的职业发展活动将使候选人能够实现她的长期目标，即成为一名独立调查员和全国公认的初级保健干预专家，这些干预措施有效地改善儿童超重和肥胖。

DESCRIPTION (provided by applicant): Childhood overweight is an important public-health problem in the US. Current estimates indicate that one in three children is overweight. Over half of overweight 5-10 year-old children have at least one cardiovascular disease risk factor, and overweight increases the lifetime risk of cardiovascular morbidity and premature death, but these risks are reduced in overweight children who attain a normal weight. During well-child visits, pediatricians have an opportunity to address weight and weight-management. Little is known, however, about clinical practice elements and pediatrician-patient communication strategies associated with weight improvement in overweight children. The overall objective of the proposed project is to identify specific clinical practice elements and pediatrician-patient communication strategies during well-child visits that predict improvement in relative weight among overweight children. This will be accomplished through three specific aims, which are to 1) identify specific clinical practice elements in pediatric primary care that predict improvement in weight status; 2) determine communication strategies that predict improvement in weight status; and 3) develop and test the feasibility and acceptability of a pilot intervention to improv pediatricians' communication and use of specific clinical practice elements when addressing weight and weight management during primary-care visits with overweight children. For Aim 1, electronic medical records (EMR) will be analyzed to determine clinical practice elements (such as lab assessments and follow-up interval) associated with improvement in weight status at one year follow-up. For Aim 2, Roter Interaction Analysis of video- recorded well-child visits will be used to analyze pediatrician-patient communication regarding weight and weight-management (including assessment and counseling regarding overweight status, and communication dynamics, including patient-centeredness), and children will be followed, by tracking interval visits, weights/heights, and referrals using the EMR, over one year. Findings from Aims 1 and 2 will be used in Aim 3 to develop and test the feasibility and acceptability of a pilot intervention aimed at improving pediatricians' observed and self-reported competence in using specific clinical practice elements and effective communication when addressing overweight during primary-care visits, compared with a control group of standard practice. The proposed Career Development Award addresses how to improve overweight/obesity management in primary care, a research priority of an NHLBI Working Group convened to set future research priorities in childhood obesity prevention and treatment. The exceptional resources and institutional support at UT Southwestern, outstanding multi-disciplinary mentorship team, and proposed career development activities will allow the candidate to achieve her long-term goal of becoming an independent investigator and nationally recognized expert on primary-care based interventions that are effective in improving childhood overweight and obesity.