Clinical-Community Approaches to Pediatric Weight Management: MA CORD 2.0

项目摘要 尽管最近在预防肥胖方面取得了进展，但美国超重和肥胖的患病率仍为 历史上的高水平以及种族/族裔和社会经济差距依然存在。许多因素促成了 肥胖症的顽固性，但有希望的预防和减少方法正在出现，包括多种， 在儿童花费时间的环境中采取协作干预措施。我们的研究成员 马萨诸塞州公共卫生部和马萨诸塞州总医院的团队 一直处于儿童肥胖预防和管理创新的前沿， 社区和环境方法。我们现在力求在这些创新战略的基础上， 优化低收入儿童的护理，身体质量指数（BMI）≥第85百分位， 更大的能量赤字将是必要的，以实现改善体重指数比那些可以实现与 社区和环境的方法。为了实现这一目标，我们提出了一个新的临床社区 干预，理论上基于综合临床和社区护理系统模式， 通过优化筛选和管理解决肥胖问题，这在星星试验中是有效的， 由MDPH开发的推荐，健康体重诊所在马萨诸塞州儿童肥胖中进行了测试 研究示范项目和基督教青年会的健康体重和你的孩子体重管理 程序（最初称为MEND）。我们将致力于实施一种高质量的护理模式， 6-12岁儿童的超重和肥胖，包括（a）计算机化的护理点决策 支持初级保健提供者改善肥胖症筛查和咨询;（B）教育材料， 交互式文本信息，用于自我指导行为改变支持;（c）与社区资源的链接，以支持 行为改变;（d）基于EHR转诊的结构化儿科体重管理。在嵌套的， 一项随机对照试验，我们还将检查儿童体重管理的比较效果， 在健康体重诊所提供的计划与基督教青年会的健康体重和你的孩子计划。我们 研究将审查对包括父母在内的广大利益攸关方最重要的儿童成果， 临床医生和公共卫生从业人员以及告知超过700万超重或肥胖儿童的护理， 儿童健康保险计划或医疗补助计划涵盖的肥胖。为了达到这些目标，我们 组建了一个多学科团队，在实施和评估范式方面具有广泛的专业知识， 转移，临床和社区体重管理计划以及健康信息的使用 将临床交付系统与社区资源连接起来的技术，以改善健康结果。 与医疗补助计划的合作将确保该计划的可持续性，如果成功， 为最需要的人群提供新的肥胖护理模式。

Project Summary Despite recent progress in obesity prevention, the prevalence of overweight and obesity in the US remains at historically high levels and racial/ethnic and socioeconomic disparities persist. Many factors contribute to the intractability of obesity but promising approaches for prevention and reduction are emerging including multi- sector, collaborative interventions across settings where children spend their time. Members of our research team at the Massachusetts Department of Public Health (MDPH) and the Massachusetts General Hospital have been at the forefront of innovation in childhood obesity prevention and management using clinical, community, and environmental approaches. We now seek to build on these innovative strategies to specifically optimize the care of low-income children with a body mass index (BMI) ≥ 85th percentile and in whom far greater energy deficits will be necessary to achieve improvements in BMI than those that can be achieved with community and environmental approaches alone. To achieve this goal, we propose a new clinical-community intervention, theoretically grounded in the Integrated Clinical and Community Systems of Care Model, to address obesity through optimized screening and management known to be effective in the STAR trial, e- Referrals developed by MDPH, Healthy Weight Clinics tested in the Massachusetts Childhood Obesity Research Demonstration project, and the YMCA's Healthy Weight and Your Child weight management program (originally known as MEND). We will aim to implement a model of high quality care for addressing overweight and obesity among 6-12 year old children that includes (a) computerized point-of-care decision supports to primary care providers to improve obesity screening and counseling; (b) educational materials and interactive text messages for self-guided behavior change support; (c) links to community resources to support behavior change; and (d) EHR-referral based, structured pediatric weight management. In a nested, randomized controlled trial we will also examine the comparative effects of a pediatric weight management program delivered in a Healthy Weight Clinic vs. the YMCA's Healthy Weight and Your Child program. Our study will examine outcomes for children that matter most to a broad group of stakeholders including parents, clinicians, and public health practitioners as well as inform the care of >7 million children with overweight or obesity covered by the Children's Health Insurance Program or Medicaid. To achieve these aims, we have assembled a multidisciplinary team with extensive expertise in implementation and evaluation of paradigm- shifting, clinical and community weight management programs as well as the use of health information technology to connect clinical delivery systems with community resources to improve health outcomes. Collaboration with Medicaid will ensure the sustainability of the program, which if successful, may provide a new model of obesity care for the very segment of the population who need it most.