Parks & Pediatrics Fit Together: Translating knowledge into action for child obesity treatment in partnership with Parks and Recreation

项目摘要/摘要 儿童肥胖症的循证治疗是存在的，但基本的知识到行动的差距已经存在 极大地限制了建议在临床实践中的应用，特别是在低收入环境中。 这种差距的持续存在是对大规模公共健康的威胁，因为 随着肥胖症的流行进入成年期，他们是美国历史上第一个寿命较短的人 比他们的父母预期的要高，主要是因为肥胖相关癌症和心血管疾病的发病率上升 疾病。提供推荐治疗的一个核心挑战是强度；≥26小时面对面 接触是实现健康益处和降低风险所必需的。长期目标是关闭 通过传播将提供当前儿童的有效实施工具来实现知识与行动之间的差距 不同社区环境下的肥胖治疗建议。拟议项目的目标是 制定和测试将初级保健儿科诊所与市政公园配对的实施战略 娱乐(P&R)中心以高保真的方式提供当前的治疗建议，同时允许 适应当地和文化背景的重要调整。中心假设是有效的儿童肥胖症 治疗是可能实现的，但只有在强有力的执行支持下才能确保证据的保真度- 基于建议和对当地资源限制和人口需求的适应性。以Strong为指导 关于有效性和实施可行性的初步数据，这一假设将通过三个阶段进行检验 具体目标：1)开发一个网络平台，支持执行和广泛传播 在低资源环境下的共享诊所-P&R模式；2)使用 中断的时间序列设计以流程重新设计框架为基础并报告定性和 提供者和组织特征、实施过程和结果的量化措施； 儿童结果和照顾者结果；以及3)设计传播和可持续发展战略，使用 PCORI传播框架，该框架考虑了相关因素，包括社区资源、资金 稳定性、组织能力、伙伴关系发展、计划要求和可持续性。这个 方法是创新的，因为它是基于价值的护理的有力范例，是替代方案的新视野 当前医疗改革环境下的支付模式。这项拟议的研究意义重大， 因为它将把实施工具送到一线儿科保健提供者手中 全国33,000个公园和娱乐中心。如果成功，预期结果将大大改善。 在不同的社区获得有效的治疗，并落实数百万人的现有建议 美国肥胖症儿童的比例。

PROJECT SUMMARY/ABSTRACT Evidence-based treatment for childhood obesity exists, yet a fundamental knowledge-to-action gap has significantly limited the uptake of recommendations into clinical practice, particularly in low-income settings. Persistence of this gap represents a large-scale public health threat, as the earliest generation of children living through the obesity epidemic now enters adulthood, they are the first in US history to have a shorter life expectancy than their parents, mainly due to rising rates of obesity-related cancers and cardiovascular disease. A central challenge in delivering recommended treatment is the intensity; ≥26 hours of face-to-face contact are necessary to achieve health benefits and risk reduction. The long-term goal is to close the knowledge-to-action gap by disseminating effective implementation tools that will deliver the current child obesity treatment recommendations in diverse community settings. The objective of the proposed project is to develop and test an implementation strategy that pairs primary care pediatric clinics with municipal Parks and Recreation (P&R) centers to deliver the current treatment recommendations with high fidelity, while allowing crucial adaptations for the local and cultural context. The central hypothesis is that effective pediatric obesity treatment is possible to achieve, but only with strong implementation supports to ensure fidelity to evidence- based recommendations and adaptability to local resource constraints and population needs. Guided by strong preliminary data on effectiveness and implementation feasibility, this hypothesis will be tested through three specific aims: 1) Develop a web-based platform that will support the implementation and broad dissemination of the shared clinic-P&R model in low-resource settings; 2) Evaluate the implementation platform using an interrupted time series design anchored in the Process Redesign Framework and reporting qualitative and quantitative measures of provider and organizational characteristics, implementation process and outcomes, child outcomes, and caregiver outcomes; and 3) Design a dissemination and sustainability strategy, using the PCORI Dissemination Framework, that considers relevant factors including community resources, funding stability, organizational capacity, partnership development, program requirements, and sustainability. The approach is innovative because it is a strong example of value-based care, a new horizon for alternative payment models in the current environment of health care reform. The proposed research is significant, because it will deliver implementation tools into the hands of front-line pediatric health care providers and over 33,000 park and recreation centers nationally. If successful, the expected outcomes will dramatically improve access to effective treatment in diverse communities, and deliver on the existing recommendations for millions of children with obesity in the United States.