Population Effects of Motivation Interviewing on Pediatric Obesity in Primary Care

 描述(由申请人提供)：我们最近完成了BMI2研究，该研究测试了从美国儿科学会PROS网络(办公室设置中的儿科研究)的39个诊所招募的2-8岁超重/肥胖青少年中两种日益强化的干预措施的有效性。治疗1组(常规护理)与治疗2组、治疗3组比较2年后体重指数百分位数。第2组包括训练有素的初级保健从业者(PCP)，他们提供4次动机访谈(MI)；第3组，除了4次PCP MI会议外，还有6次MI会议，由训练有素的注册营养师(RD)与每个实践联系起来。在两年的随访中，常规护理组、单纯PCP组和PCP+RD组的调整后BMI百分位数分别为90.3、88.1和87.1。PCP+RD组的平均值显著低于UC组。我们研究的下一个合乎逻辑的步骤是测试BMI干预在所有患者中的人口效应，当干预在更真实的世界条件下进行时。拟议的研究将测试通过18项专业实践(未参与BMI2研究)传播的BMI2干预的增强版本的有效性。主要目的将是根据共享的电子健康记录数据，确定干预措施(BMI百分位数的变化)对这18个地点3-10岁超重和肥胖青年的整个人口的影响。我们将对所有诊所进行配对并将其随机分配到普通护理或BMI2。对于被分配到BMI2的诊所，所有PCP将接受MI和BMI2干预方面的培训。为了使干预规模扩大，将对干预进行一些关键的改变。首先，尽管BMI2的效果很有希望，但只有27%(37/141)的第三组参与者暴露在&gt；=75%的计划MI剂量下。这主要是由于RD咨询完成率较低，在6次咨询中只有2.7次。我们将通过几种方式增加剂量。首先，我们将添加双向定制短信。父母每周将收到1-2条短信，根据他们的家庭行为量身定做。此外，他们将收到即将到来的MI电话的提醒，并提醒他们安排孩子的评估。我们将通过我们的健康交流中心(CHCR)的集中疾病管理系统来实施RD咨询。通过将研发咨询集中在密歇根大学，我们将能够大幅提高研发干预的剂量和质量，从而提高干预效果。通过使用训练有素的办公室经理来接近所有符合条件的家庭(儿童和>85%)，将最大限度地扩大覆盖范围。主要结果是两年后BMI z评分的变化。第二个假设将探索暴露在干预中的青年亚样本中BMI的变化。探索性目标包括量化这些诊所与肥胖相关的咨询产生的收入，并比较BMI2和普通护理诊所之间的收入。RE-AIM框架将指导对干预组和UC组的覆盖范围、传播和实施的分析。

 DESCRIPTION (provided by applicant):We recently completed the BMI2 study, which tested the efficacy of two increasingly intensive interventions among overweight/obese youth ages 2-8 recruited from 39 practices in the American Academy of Pediatrics PROS network (Pediatric Research in Office Settings). Group 1 (Usual Care) was compared with treatment Groups 2 and 3 on BMI percentile at 2-year follow up. Group 2 comprised trained primary care practitioners (PCPs) who delivered 4 motivational interviewing (MI) sessions and Group 3, in addition to the 4 PCP MI sessions, had 6 MI sessions delivered by trained Registered Dietitians (RDs) linked with each practice. At two- year follow-up, the adjusted BMI percentile was 90.3, 88.1, and 87.1 for Usual Care, PCP only, and PCP + RD groups, respectively. The PCP + RD group mean was significantly lower than the UC group. A next logical step in our research is to test the populatio effect of the BMI intervention among all patients, when the intervention is delivered under more real world conditions. The proposed study will test the effectiveness of an enhanced version of the BMI2 intervention disseminated through 18 PROS practices (not participating in the BMI2 study). The primary aim will be to determine the impact of the intervention (change in BMI percentile) on the entire population of overweight and obese youth ages 3-10 in these 18 sites, based on shared Electronic Health Record data. We will pair-match and randomize all clinics to the either Usual Care or BMI2. For clinics assigned to BMI2, all PCPs will be trained in MI and the BMI2 intervention. To bring the intervention to scale, some key changes will be made to the intervention. First, despite the promising effects of BMI2, only 27% (37/141) of Group 3 participants were exposed to >=75% of the planned MI dose. This was due primarily to low completion of the RD counseling, only 2.7 out of 6 sessions were delivered. We will increase dose in several ways. First, we will add two-way tailored text messaging. Parents will receive 1-2 SMS per week, tailored to their family behaviors. In addition they will receive reminders for upcoming MI calls and reminders to schedule their child's assessments. We will implement the RD counseling through a centralized disease management system at our Center for Health Communications (CHCR). By centralizing the RD counseling at the U of M, we will be able to substantially increase the dose and quality of the RD intervention, and therefore increase intervention impact. Reach will be maximized by using trained office managers to approach all eligible families (child >85th percentile). The primary outcome is change in BMI z-score at two year followup. Secondary Hypothesis will explore BMI change among the subsample of youth exposed to the intervention. Exploratory Aims include quantifying revenue generated from obesity-related counseling at these clinics and compare revenue between the BMI2 and usual care clinics. The RE-AIM framework will guide analysis of reach, dissemination, and implementation in both the intervention and UC groups.