Building Evidence for High-Quality Pediatric Primary Care Weight and Comorbidity Management

项目总结 大多数供应商都知道，每三个美国儿童中就有一个超重。更少的人认识到严重肥胖是 在发育较早的情况下，心脏代谢危险因素甚至在蹒跚学步的儿童中也能看到，而且与肥胖相关的疾病 以前只在成人中出现，现在在儿童中被诊断出来。然而，这些风险在超重时会降低。 达到正常体重的儿童。在初级保健访问期间，儿科医生有机会解决 体重和体重管理。尽管美国儿科学会和美国预防服务 工作组建议提供者识别超重/肥胖，评估医疗风险，并使用阶段性 治疗和重新评估的方法，几乎不知道是否进行这些推荐的临床 常规练习与体重或代谢危险因素的改善有关。 拟议研究的总体目标是确定具体的临床实践和重新评估。 在改善体重状况和心脏代谢危险因素方面有效的初级保健策略 超重和肥胖的2-18岁儿童。这将通过三个具体目标来实现， 1)确定用于识别和管理肥胖的推荐临床实践以及 相关条件与2-18岁儿童体重状况的改善有关；2)确定 这些推荐的临床实践是否影响心脏代谢危险因素的改善；以及 检查三种重新评估策略的影响--不重新评估、更频繁地到初级保健机构就诊，或者 营养/全面体重管理计划访问-关于减肥和风险因素改善。 对于所有目标，从电子健康记录(EHR)提取的现有数据将被分析以确定临床 实践要素(如身体质量指数筛查、实验室评估、转诊和随访间隔) 与体重状况和心脏代谢风险因素的改善有关。对于目标2，实验室结果 血压值将被用来分析特定的临床实践元素与 心脏代谢危险因素改善。在目标3中，检查来自目标1的临床实践的影响 重新评估战略(不进行重新评估的后续访问，更频繁的初级保健访问，或 营养/全面体重管理计划访问)，我们将研究长达六年的纵向数据 关于相对体重和风险因素的变化，通过后续访问，转诊到营养和 全面的体重管理方案，并恢复常规初级保健(在转诊结束后 和程序)。建议的研究针对如何改善小学超重/肥胖的管理。 CARE，NIDDK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， 优秀的多学科团队，拟议的研究将使初级保健干预措施增加 高质量地筛查和管理超重、肥胖和相关的合并症，以实现 改善长期结果。

PROJECT SUMMARY Most providers know that one in three US children is overweight. Fewer recognize that severe obesity is developing earlier, cardiometabolic risk factors are seen even in toddlers, and that obesity-related diseases formerly seen only in adults now are diagnosed in children. These risks are reduced, though, in overweight children who attain a normal weight. During primary-care visits, pediatricians have an opportunity to address weight and weight-management. Although the American Academy of Pediatrics and US Preventive Services Task Force recommend that providers identify overweight/obesity, assess medical risk, and use a staged treatment and reassessment approach, little is known about whether performing these recommended clinical practices in routine practice is associated with improvement in weight or metabolic risk factors. The overall objective of the proposed studies is to identify specific clinical practices and reassessment strategies in primary care that are effective in improving weight status and cardiometabolic risk factors among 2-18 year-old children with overweight and obesity. This will be accomplished through three specific aims, which are to 1) identify whether recommended clinical practices for identifying and managing obesity and related conditions are associated with weight-status improvement in 2-18 year-old children; 2) determine whether these recommended clinical practices impact cardiometabolic risk-factor improvement; and 3) examine the impact of three reassessment strategies—no reassessment, more frequent primary-care visits, or nutrition/comprehensive weight-management program visits—on weight reduction and risk-factor improvement. For all Aims, existing data extracted from electronic health records (EHR) will be analyzed to determine clinical practice elements (such as body-mass-index screening, lab assessments, referrals, and follow-up intervals) associated with improvement in weight status and cardiometabolic risk factors. For Aim 2, laboratory results and blood-pressure values will be used to analyze the association of specific clinical practice elements with cardiometabolic risk-factor improvement. In Aim 3, to examine impact of clinical practices from Aim 1 with three reassessment strategies (no follow-up visits for reassessment, more frequent primary-care visits, or nutrition/comprehensive weight-management-program visits), we will study up to six years of longitudinal data regarding relative weight and risk-factor changes through follow-up visits, referrals to nutrition and comprehensive weight-management programs, and return to routine primary care (upon conclusion of referrals and programs). The proposed studies address how to improve overweight/obesity management in primary care, a research priority of NIDDK. The exceptional resources and institutional support at UT Southwestern, outstanding multi-disciplinary team, and proposed studies will inform primary-care interventions to increase high-quality screening and management of overweight, obesity, and related comorbidities, toward the goal of improved long-term outcomes.