Primary Care, Communication, & Improving Children's Health

描述（由申请人提供）：儿童超重是美国一个重要的公共卫生问题。目前的估计表明，三分之一的儿童超重。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发病率和过早死亡的终生风险，但体重正常的超重儿童的这些风险会降低。在健康儿童访问期间，儿科医生有机会解决体重和体重管理问题。然而，关于临床实践因素和儿科医患沟通策略与超重儿童体重改善的关系，我们知之甚少。拟议项目的总体目标是确定在健康儿童访问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-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；3)制定并测试一项试点干预措施的可行性和可接受性，以改善儿科医生在对超重儿童进行初级保健访问时处理体重和体重管理时对特定临床实践要素的沟通和使用。对于目标1，将分析电子医疗记录（EMR），以确定与一年随访时体重状况改善相关的临床实践因素（如实验室评估和随访间隔）。在目标2中，将使用录像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），并通过跟踪间隔访问、体重/身高和使用电子病历的转诊，对儿童进行为期一年的跟踪。目标1和2的研究结果将用于目标3，以制定和测试试点干预措施的可行性和可接受性

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.