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Fayyaz H, Phan TLT, Bunnell HT, Beheshti R. Predicting Attrition Patterns from Pediatric Weight Management Programs. PROCEEDINGS OF MACHINE LEARNING RESEARCH 2022; 193:326-342. [PMID: 36686987 PMCID: PMC9854275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Obesity is a major public health concern. Multidisciplinary pediatric weight management programs are considered standard treatment for children with obesity who are not able to be successfully managed in the primary care setting. Despite their great potential, high dropout rates (referred to as attrition) are a major hurdle in delivering successful interventions. Predicting attrition patterns can help providers reduce the alarmingly high rates of attrition (up to 80%) by engaging in earlier and more personalized interventions. Previous work has mainly focused on finding static predictors of attrition on smaller datasets and has achieved limited success in effective prediction. In this study, we have collected a five-year comprehensive dataset of 4,550 children from diverse backgrounds receiving treatment at four pediatric weight management programs in the US. We then developed a machine learning pipeline to predict (a) the likelihood of attrition, and (b) the change in body-mass index (BMI) percentile of children, at different time points after joining the weight management program. Our pipeline is greatly customized for this problem using advanced machine learning techniques to process longitudinal data, smaller-size data, and interrelated prediction tasks. The proposed method showed strong prediction performance as measured by AUROC scores (average AUROC of 0.77 for predicting attrition, and 0.78 for predicting weight outcomes).
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Rhee KE, Herrera L, Strong D, Kang-Sim E, Shi Y, Boutelle KN. Guided Self-Help for Pediatric Obesity in Primary Care: A Randomized Clinical Trial. Pediatrics 2022; 150:188283. [PMID: 35712916 DOI: 10.1542/peds.2021-055366] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Our aim was to compare the effect of 2 treatment models on attendance and child weight status: a less intense guided self-help (GSH) program delivered in the primary care setting versus traditional family-based behavioral treatment (FBT) delivered in an academic center. METHODS We conducted a randomized clinical trial among 164 children between 5 and 13 years old with a BMI ≥85th percentile and their parents. The intervention group (GSH) received 14 individual sessions over 6 months, with 5.3 hours of treatment. The control group (FBT) received 20 group-based sessions over 6 months, with 20 hours of treatment. Main outcomes included proportion of sessions families attended and change in child BMI z-score (BMIz), percentage from the 95th BMI percentile, difference from the 95th BMI percentile at the end of treatment, and 6-month follow-up. RESULTS Mean age of children was 9.6 years, BMI z-score 2.1, 49% female, and >90% Latino. The odds of attending GSH compared to FBT was 2.2 (P < 0.01). Those assigned to GSH had a 67% reduced risk of attrition (hazard ratio = 0.33, 95% confidence interval 0.22-0.50, P < .001). Intent-to-treat analysis showed no between-group differences in change in BMIz and percentage from the 95th BMI percentile over time. Combined, there was a significant reduction in BMIz from baseline to posttreatment (β = -0.07 (0.01), P < .01, d: 0.60) and a slight increase from posttreatment to follow-up (β = 0.007 (0.13), P = .56). CONCLUSIONS This study provides support for a novel, less intense GSH model of obesity treatment, which can be implemented in the primary care setting. Future studies should examine effective approaches to dissemination and implementation of GSH in different settings to increase access to treatment.
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Affiliation(s)
| | - Lourdes Herrera
- Department of Pediatrics, Wake Forrest University, Winston-Salem, North Carolina
| | | | | | | | - Kerri N Boutelle
- Departments of Pediatrics.,Family Medicine and Public Health.,Psychiatry, University of California San Diego, San Diego, California
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Else V, Chen Q, Cortez AB, Koebnick C. Sustainability of weight loss from a family-centered pediatric weight management program integrated in primary care. BMC Health Serv Res 2022; 22:12. [PMID: 34974835 PMCID: PMC8720465 DOI: 10.1186/s12913-021-07361-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A 6-month pediatric weight loss program showed modest success, but the sustainability of this success after 12 months was unclear. The present study aims tomeasure the medium-term effectiveness of family-based weight management in pediatric primary care to reduce body weight in children living with obesity. METHODS In a retrospective cohort study, children ages 3 to 17 years with obesity in Kaiser Permanente Orange County, California, who enrolled in a weight management program between April 2014 and December 2018 (FB-WMG, n = 341) were compared to children referred but not enrolled (Ref-CG, n = 317) and controls matched by sex, age, zip code and BMI (Area-CG, n = 801). The relative distance from the median BMI-for-age at months 0, 6, and 12 were expressed as difference-in-differences (DID) using multivariable linear regressions with robust standard error. RESULTS The baseline BMI-for-age was 98.6 (SD 1.08) percentile in FB-WMG, 98.2 (SD 1.22) percentile in Ref-CG, and 98.6 (1.13 in Area-CG). FB-WMG had a median of 3 visits (P25 1 visit, P75 5 visits) in the first 6 months. Despite a more considerable decrease in the relative distance to the median BMI-for-age in FB-WMG children with 3+ visits after 6 months, the success obtained was not sustained at 12 months (DID FB-WMG vs Area-CG -0.34, 95% CI - 3.00 to 2.33%, FB-WMG vs Ref-CG -0.39, 95% CI - 3.14 to 2.35%). At 12 months, there was no statistical significant difference between the three groups (FB-WWG, Ref-CG, Area-CG). CONCLUSIONS The initial success in weight management was not sustained in the absence of continued support for healthy lifestyle changes. Based on current evidence, continued support is necessary to maintain and promote success beyond a brief 6 month intervention. Long-term pediatric weight management programs are needed to promote continuing progress.
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Affiliation(s)
- Veronica Else
- Southern California Permanente Medical Group, Kaiser Permanente Yorba Linda Medical Offices, 22550 Savi Ranch Parkway, Yorba Linda, CA, 92887, USA.
| | - Qiaoling Chen
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Alan B Cortez
- Southern California Permanente Medical Group, Kaiser Permanente Tustin Ranch, Tustin, California, USA
| | - Corinna Koebnick
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
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Romero B, Fry M, Roche M. Measuring sustainable practice change of the sepsis guideline in one emergency department: A retrospective health care record audit. Int Emerg Nurs 2021; 60:101108. [PMID: 34952484 DOI: 10.1016/j.ienj.2021.101108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/07/2021] [Accepted: 10/22/2021] [Indexed: 11/05/2022]
Abstract
AIMS AND OBJECTIVES To explore the longitudinal impact of the New South Wales Sepsis guideline on time to antibiotics, triage assessment and emergency management before and four years after guideline implementation. BACKGROUND Globally, sepsis continues to be a significant cause of mortality and morbidity within hospitals. To reduce avoidable adverse patient outcomes the corner stone has been to improve the early recognition and management of sepsis. The New South Wales government in Australia introduced sepsis guidelines into Emergency Departments. However, the longitudinal impact of the sepsis guideline, has never been conducted. METHODS A 12-month retrospective randomised health care record audit of adult patients with a sepsis diagnosis was conducted 12-months before and four years after implementation of the sepsis guideline. RESULTS This study demonstrated sustained improvement in allocation of urgent triage categories in the follow-up group (n = 43; 53.1%) and a reduction in the median time to antibiotics from 189 min to 102 min (p ≤ 0.001) after the implementation of the sepsis guideline. CONCLUSION The study has demonstrated the sepsis guideline has improved a sustained change in early assessment, recognition and management of patients presenting with sepsis in one tertiary referral Emergency Department.
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Affiliation(s)
- Bernadine Romero
- Faculty of Health School of Nursing and Midwifery, University of Technology Sydney, NSW, Australia.
| | - Margaret Fry
- Faculty of Health School of Nursing and Midwifery, University of Technology Sydney, NSW, Australia
| | - Michael Roche
- Faculty of Health, University of Canberra, ACT, Australia
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Improving Care for Childhood Obesity: A Quality Improvement Initiative. Pediatr Qual Saf 2021; 6:e412. [PMID: 34046541 PMCID: PMC8143745 DOI: 10.1097/pq9.0000000000000412] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 12/04/2020] [Indexed: 11/29/2022] Open
Abstract
Obesity affected 13.7 million children in the United States in 2015. The American Academy of Pediatrics (AAP) offers an evidence-based approach to obesity management, but adherence to recommendations is suboptimal. Our objective was to improve provider adherence to the AAP recommendations for care of patients with obesity by making systematic changes in our practice for patients of ages > 2 and younger than 19 years with a BMI > 95th percentile.
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Rhee KE, Herrera L, Strong D, DeBenedetto AM, Shi Y, Boutelle KN. Design of the GOT Doc study: A randomized controlled trial comparing a Guided Self-Help obesity treatment program for childhood obesity in the primary care setting to traditional family-based behavioral weight loss. Contemp Clin Trials Commun 2021; 22:100771. [PMID: 33997462 PMCID: PMC8095104 DOI: 10.1016/j.conctc.2021.100771] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 03/11/2021] [Accepted: 04/05/2021] [Indexed: 11/26/2022] Open
Abstract
Currently one-third of children in the United States have overweight or obesity (OW/OB). The goal of Healthy People 2020 is to reduce the proportion of children with OW/OB and increase the proportion of primary care visits that include nutrition and weight-related counseling. Unfortunately, many health care providers find it difficult to offer effective weight-related counseling and treatment in the primary care setting. Therefore, new models of care are needed that allow a greater proportion of children with OW/OB and their parents to access care and receive quality weight management treatment. The current paper describes the GOT Doc study which is designed to test the effectiveness of a Guided Self-Help (GSH) model of obesity treatment that can be delivered in the primary care setting compared to a traditional Family-Based Behavioral weight loss treatment (FBT) delivered at an academic center. We will assess the impact of this program on attendance (access to care) and changes in child BMI percentile/z-score. We will also examine the impact of this treatment model on change in child lifestyle behaviors, parent support behaviors, and parent self-efficacy and empowerment to make behavior change. Finally, we will assess the cost-effectiveness of this model on changes in child BMI percentile/z-score. We believe the GSH intervention will be a cost-effective model of obesity management that can be implemented in community practices around the country, thereby increasing access to treatment for a broader proportion of our population and decreasing rates of childhood obesity. Effective childhood obesity treatment is not widely available or easily accessible. Guided Self-Help (GSH) model of treatment has been developed for pediatric obesity. GSH is easier to implement and can be delivered in the primary care setting. GSH can increase access to much needed treatment. Evaluation of its effectiveness in the primary care setting is needed.
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Key Words
- Childhood obesity
- Community-based intervention
- Early and Periodic Screening, Diagnosis, and Treatment program, EPSDT
- Electronic health record, EHR
- Family-Based Behavioral Therapy, FBT
- Family-based behavioral therapy
- Guided Self-Help, GSH
- Guided self-help
- Guided self-help Obesity Treatment in the primary care setting, GOT Doc
- Overweight or obesity, OW/OB
- Primary care
- Primary care provider, PCP
- Quality of Lifev, QOL
- Treatment
- U.S. Preventive Services Task Force, USPSTF
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Affiliation(s)
- Kyung E Rhee
- University of California, San Diego, Department of Pediatrics, United States
| | - Lourdes Herrera
- University of California, San Diego, Department of Pediatrics, United States.,Wake Forrest University, Department of Pediatrics, United States
| | - David Strong
- University of California, San Diego, Department of Family Medicine and Public Health, United States
| | | | - Yuyan Shi
- University of California, San Diego, Department of Family Medicine and Public Health, United States
| | - Kerri N Boutelle
- University of California, San Diego, Department of Pediatrics, Department of Family Medicine and Public Health, And Department of Psychiatry, United States
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Kepper MM, Walsh-Bailey C, Brownson RC, Kwan BM, Morrato EH, Garbutt J, de las Fuentes L, Glasgow RE, Lopetegui MA, Foraker R. Development of a Health Information Technology Tool for Behavior Change to Address Obesity and Prevent Chronic Disease Among Adolescents: Designing for Dissemination and Sustainment Using the ORBIT Model. Front Digit Health 2021; 3:648777. [PMID: 34713122 PMCID: PMC8521811 DOI: 10.3389/fdgth.2021.648777] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 02/10/2021] [Indexed: 11/13/2022] Open
Abstract
Health information technology (HIT) has not been broadly adopted for use in outpatient healthcare settings to effectively address obesity in youth, especially among disadvantaged populations that face greater barriers to good health. A well-designed HIT tool can deliver behavior change recommendations and provide community resources to address this gap, and the Obesity-Related Behavioral Intervention Trials (ORBIT) model can guide its development and refinement. This article reports the application of the ORBIT model to (1) describe the characteristics and design of a novel HIT tool (the PREVENT tool) using behavioral theory, (2) illustrate the use of stakeholder-centered "designing for dissemination and sustainability" principles, and (3) discuss the practical implications and directions for future research. Two types of stakeholder engagement (customer discovery and user testing) were conducted with end users (outpatient healthcare teams). Customer discovery interviews (n = 20) informed PREVENT tool components and intervention targets by identifying (1) what healthcare teams (e.g., physicians, dietitians) identified as their most important "jobs to be done" in helping adolescents who are overweight/obese adopt healthy behaviors, (2) their most critical "pains" and "gains" related to overweight/obesity treatment, and (3) how they define success compared to competing alternatives. Interviews revealed the need for a tool to help healthcare teams efficiently deliver tailored, evidence-based behavior change recommendations, motivate patients, and follow-up with patients within the constraints of clinic schedules and workflows. The PREVENT tool was developed to meet these needs. It facilitates prevention discussions, delivers tailored, evidence-based recommendations for physical activity and food intake, includes an interactive map of community resources to support behavior change, and automates patient follow-up. Based on Self-Determination Theory, the PREVENT tool engages the patient to encourage competence and autonomy to motivate behavior change. The use of this intentional, user-centered design process should increase the likelihood of the intended outcomes (e.g., behavior change, weight stabilization/loss) and ultimately increase uptake, implementation success, and long-term results. After initial tool development, user-testing interviews (n = 13) were conducted using a think-aloud protocol that provided insight into users' (i.e., healthcare teams) cognitive processes, attitudes, and challenges when using the tool. Overall, the PREVENT tool was perceived to be useful, well-organized, and visually appealing.
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Affiliation(s)
- Maura M. Kepper
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
- Institute for Public Health, Washington University in St. Louis, St. Louis, MO, United States
| | - Callie Walsh-Bailey
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Ross C. Brownson
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
- Institute for Public Health, Washington University in St. Louis, St. Louis, MO, United States
- Division of Public Health Sciences, Department of Surgery, Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Bethany M. Kwan
- Department of Family Medicine, Adult & Child Consortium for Health Outcomes Research & Delivery Science, University of Colorado Anschutz Medical Camps, Aurora, CO, United States
| | - Elaine H. Morrato
- Department of Family Medicine, Adult & Child Consortium for Health Outcomes Research & Delivery Science, University of Colorado Anschutz Medical Camps, Aurora, CO, United States
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, United States
| | - Jane Garbutt
- Institute for Public Health, Washington University in St. Louis, St. Louis, MO, United States
- Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Lisa de las Fuentes
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Russell E. Glasgow
- Department of Family Medicine, Adult & Child Consortium for Health Outcomes Research & Delivery Science, University of Colorado Anschutz Medical Camps, Aurora, CO, United States
| | - Marcelo A. Lopetegui
- Centro de Informática Biomédica, Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Randi Foraker
- Institute for Public Health, Washington University in St. Louis, St. Louis, MO, United States
- Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States
- Center for Population Health Informatics, Institute for Informatics, Washington University in St. Louis, St. Louis, MO, United States
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Kepper M, Walsh-Bailey C, Staiano A, Fowler LA, Gacad A, Blackwood A, Fowler SA, Kelley M. Health Information Technology Use Among Healthcare Providers Treating Children and Adolescents With Obesity: a Systematic Review. CURR EPIDEMIOL REP 2021. [DOI: 10.1007/s40471-021-00262-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kosowan L, Page J, Protudjer J, Williamson T, Queenan J, Singer A. Characteristics associated with pediatric growth measurement collection in electronic medical records: a retrospective observational study. BMC FAMILY PRACTICE 2020; 21:191. [PMID: 32933471 PMCID: PMC7490864 DOI: 10.1186/s12875-020-01259-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 09/02/2020] [Indexed: 11/23/2022]
Abstract
Background Complete growth measurements are an essential part of pediatric care providing a proxy for a child’s overall health. This study describes the frequency of well-child visits, documented growth measurements, and clinic and provider factors associated with measurement. Methods Retrospective cross-sectional study utilizing electronic medical records (EMRs) from primary care clinics between 2015 and 2017 in Manitoba, Canada. This study assessed the presence of recorded height, weight and head circumference among children (0–24 months) who visited one of 212 providers participating in the Manitoba Primary Care Research Network. Descriptive and multivariable logistic regression analyses assessed clinic, provider, and patient factors associated with children having complete growth measurements. Results Our sample included 4369 children. The most frequent growth measure recorded was weight (79.2% n = 3460) followed by height (70.8% n = 3093) and head circumference (51.4% n = 2246). 67.5% of children (n = 2947) had at least one complete growth measurement recorded (i.e. weight, height and head circumference) and 13.7% (n = 599) had complete growth measurements at all well-child intervals attended. Pediatricians had 2.7 higher odds of documenting complete growth measures within well-child intervals compared to family physicians (95% CI 1.8–3.8). Additionally, urban located clinics (OR 1.7, 95% CI 1.2–2.5), Canadian trained providers (OR 2.3, 95% CI 1.4–3.7), small practice size (OR 1.6, 95% CI 1.2–2.2) and salaried providers (OR 3.4, 95% CI 2.2–5.2) had higher odds of documented growth measures. Conclusions Growth measurements are recorded in EMRs but documentation is variable based on clinic and provider factors. Pediatric growth measures at primary care appointments can improve primary prevention and surveillance of child health outcomes.
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Affiliation(s)
- Leanne Kosowan
- Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - John Page
- The Children's Hospital of Winnipeg, Winnipeg, Manitoba, Canada
| | - Jennifer Protudjer
- Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tyler Williamson
- Departments of Biostatistics & Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - John Queenan
- Centre for Studies in Primary Care, Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
| | - Alexander Singer
- Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
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Kaufman TK, Gentile N, Kumar S, Halle M, Lynch BA, Cristiani V, Fischer K, Chaudhry R. Impact of Point-of-Care Decision Support Tool on Laboratory Screening for Comorbidities in Children with Obesity. CHILDREN (BASEL, SWITZERLAND) 2020; 7:E67. [PMID: 32605041 PMCID: PMC7401862 DOI: 10.3390/children7070067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 06/17/2020] [Accepted: 06/24/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Childhood obesity is associated with dyslipidemia, fatty liver disease, and type 2 diabetes. Expert guidelines recommend screening for these conditions in children with obesity. AIMS AND OBJECTIVES The objective of the study was to compare rates of laboratory screening for dyslipidemia, fatty liver disease, and type 2 diabetes in children with obesity prior to and following implementation of a point-of-care decision support tool. METHODS We performed a retrospective record review of children with body mass index (BMI) ≥95th percentile for age and gender (age 7-18 years) undergoing well-child/sports examination visits. Multivariable logistic regression models were used to adjust for patient and provider confounders. RESULTS There was no increase in the rates of screening following implementation of the point-of-care decision support tool. Tests were more likely to be recommended in children with severe obesity and in females. CONCLUSIONS The implementation of a point-of-care decision support tool was not associated with improvement in screening rates for dyslipidemia, fatty liver disease, and type 2 diabetes for children with obesity. Further strategies are needed to improve rates of screening for obesity-related comorbid conditions in children with obesity.
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Affiliation(s)
- Tara K. Kaufman
- Department of Family Medicine, Mayo Clinic, Rochester, MN 55905, USA; (T.K.K.); (N.G.)
| | - Natalie Gentile
- Department of Family Medicine, Mayo Clinic, Rochester, MN 55905, USA; (T.K.K.); (N.G.)
| | - Seema Kumar
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Marian Halle
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA; (M.H.); (K.F.); (R.C.)
| | - Brian A. Lynch
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA; (B.A.L.); (V.C.)
| | - Valeria Cristiani
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA; (B.A.L.); (V.C.)
| | - Karen Fischer
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA; (M.H.); (K.F.); (R.C.)
| | - Rajeev Chaudhry
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA; (M.H.); (K.F.); (R.C.)
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Rust C, Prior RM, Stec M. Implementation of a clinical practice guideline in a primary care setting for the prevention and management of obesity in adults. Nurs Forum 2020; 55:485-490. [PMID: 32243604 DOI: 10.1111/nuf.12453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 03/27/2020] [Accepted: 03/28/2020] [Indexed: 11/30/2022]
Abstract
Over two-thirds of American adults have obesity or overweight, increasing the risk of comorbidities, mortality, and healthcare costs. Despite this growing issue, screening and counseling for an unhealthy weight are not common in primary care and clinical practice guidelines (CPGs) for prevention and management of obesity are underutilized. Following the stepwise approach outlined in the Registered Nurses' Association of Ontario Toolkit: Implementation of Best Practice Guidelines, the Institute for Clinical Systems Improvement: Prevention and Management of Obesity for Adults were implemented in a primary care office in Lexington, KY. Education was implemented with providers and staff. An assessment of readiness for change was completed at check-in and customizable phrases were built into the electronic health record. After a 12-week implementation, providers were consistently assessing for comorbidities, setting goals, and managing weight in those with obesity using evidence-based strategies. Readiness for change was being documented in less than 40% of those patients. For those with overweight providers were assessing readiness for change in only 30% of patients and were setting goals in just over 40% of patients. After the implementation, care more closely followed the CPG but additional steps are necessary to improve the prevention and management of obesity in this population.
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Affiliation(s)
- Chelsea Rust
- Baptist Health Center for Medical Weight Loss, Lexington, Kentucky
| | - Richard M Prior
- College of Nursing, University of Cincinnati, Cincinnati, Ohio
| | - Melissa Stec
- College of Nursing, SUNY Downstate Health Sciences University, Brooklyn, New York
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Harnessing the Electronic Health Record to Distribute Transition Services to Adolescents With Inflammatory Bowel Disease. J Pediatr Gastroenterol Nutr 2020; 70:200-204. [PMID: 31978017 DOI: 10.1097/mpg.0000000000002516] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The aim of the study was to evaluate feasibility and utility of an electronic health record (EHR) activity to assess transitional readiness, deliver services to meet individual needs, and to track patient progress. METHODS We developed a Transition EHR activity (TEA) to track patients through a standardized process where transition readiness is annually assessed and services distributed based on need. The process assesses transition skills starting at age 12 years and sets goals through shared decision-making, delivers resources according to need, reviews patients' personal medical histories, and documents healthcare transfer to adult gastroenterology. We piloted TEA among patients with inflammatory bowel disease (IBD) ages ≥12 years. Distribution to patients was measured and tolerability assessed via patient self-report evaluations. RESULTS Since launch, TEA has been distributed to all eligible patients (N = 53) with a median age of 16 (14,18) years (median [IQR]), 62% male, 58% white, 26% Hispanic at our weekly dedicated IBD clinic. All have performed the transition skills' self-assessment and practicum, and set transition goals with their healthcare provider. Of these individuals, 41 (77%) participated in survey feedback. On a utility rating scale of 0 (not helpful at all) to 10 (very helpful), patients reported median (IQR) utility scores of 8 (7,10) for the transition readiness assessment, 9 (7,10) for transition resources provided, and 9 (7,10) for the medical history summary. Most (91%) would recommend TEA to other patients. CONCLUSIONS TEA standardized delivery of resources among pediatric IBD patients and was well received and friendly to clinical workflow.
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Bailey‐Davis L, Kling SMR, Wood GC, Cochran WJ, Mowery JW, Savage JS, Stametz RA, Welk GJ. Feasibility of enhancing well-child visits with family nutrition and physical activity risk assessment on body mass index. Obes Sci Pract 2019; 5:220-230. [PMID: 31275595 PMCID: PMC6587309 DOI: 10.1002/osp4.339] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 03/14/2019] [Accepted: 03/22/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Integration of behavioural risk assessment into well-child visits is recommended by clinical guidelines, but its feasibility and impact is unknown. METHODS A quasi-experimental study evaluated the feasibility and effectiveness of risk assessment on body mass index (BMI) at 1-year follow-up. Children with assessments (intervention) were compared with those who did not complete assessments (non-respondent) and those who received standard care (non-exposed). RESULTS Analyses included 10,647 children aged 2-9 years (2,724 intervention, 3,324 non-respondent and 4,599 non-exposed). Forty-five per cent of parents completed the assessments. Intervention and non-respondent groups differed in change in BMI z-score at 1 year by -0.05 (confidence interval [CI]: -0.08, -0.02; P = 0.0013); no difference was observed with non-exposed children. The intervention group had a smaller increase in BMI z-score (0.07 ± 0.63) than non-respondent group (0.13 ± 0.63). For children with normal weight at baseline, intervention versus non-respondent groups differed in BMI z-score change by -0.06 (CI: -0.10, -0.02; P = 0.0025). However, children with overweight at baseline in the intervention versus the non-exposed group differed in BMI z-score change (0.07 [CI: 0.02, 0.14]; P = 0.016). When analysed by age, results were similar for 2- to 5-year-olds, but no differences were found for 6- to 9-year-olds. CONCLUSION Automating risk assessment in paediatric care is feasible and effective in promoting healthy weight among preschool but not older children.
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Affiliation(s)
- L. Bailey‐Davis
- Geisinger Obesity InstituteGeisingerDanvillePAUSA
- Department of Nutritional SciencesThe Pennsylvania State University, University ParkState CollegePAUSA
| | - S. M. R. Kling
- Department of Nutritional SciencesThe Pennsylvania State University, University ParkState CollegePAUSA
| | - G. C. Wood
- Geisinger Obesity InstituteGeisingerDanvillePAUSA
| | | | - J. W. Mowery
- Geisinger Obesity InstituteGeisingerDanvillePAUSA
| | - J. S. Savage
- Center for Childhood Obesity Research, Department of Nutritional SciencesThe Pennsylvania State University, University ParkState CollegePAUSA
| | - R. A. Stametz
- Steele Institute for Health InnovationGeisingerDanvillePAUSA
| | - G. J. Welk
- Department of KinesiologyIowa State UniversityAmesIAUSA
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Imoisili OE, Goodman AB, Dooyema CA, Harrison MR, Belay B, Park S. Screening and Referral for Childhood Obesity: Adherence to the U.S. Preventive Services Task Force Recommendation. Am J Prev Med 2019; 56:179-186. [PMID: 30573333 PMCID: PMC10863670 DOI: 10.1016/j.amepre.2018.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/30/2018] [Accepted: 10/01/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The U.S. Preventive Services Task Force recommends clinicians screen children aged 6 years or older for obesity and offer or refer children with obesity to intensive weight management programs. This study explores clinician awareness of weight management programs meeting the recommendation, adherence to the recommendation of screening and referral, and associations between provider and practice characteristics and weight management program referrals. METHODS This cross-sectional study used data from the DocStyles survey 2017, a web-based panel survey, analyzed in 2017. Among 1,023 clinicians who see pediatric patients, this study examined clinician awareness of weight management programs in their communities that met the recommendation, practice of screening for childhood obesity, and referral to weight management programs. Multivariable logistic regression estimated associations between the demographic and practice characteristics of clinicians and weight management program referrals. RESULTS Only 24.6% of surveyed clinicians were aware of a weight management program that met the U.S. Preventive Services Task Force recommendation in their community; of those aware, 88.9% referred patients to these weight management programs. Most (83.6%) clinicians screened children for obesity in ≥75% of visits. Overall, 53.5% of clinicians provided referrals to weight management programs. Referral was higher among female clinicians and clinicians serving mostly middle-income patients. Providers without teaching hospital privileges had lower odds of referral. CONCLUSIONS Adherence to clinical recommendations is essential to curbing the childhood obesity epidemic. Only one in four surveyed clinicians were aware of weight management programs in their community meeting U.S. Preventive Services Task Force criteria. Half of clinicians referred pediatric patients with obesity to a weight management program. Results suggest efforts are needed to increase awareness of, and referral to, weight management programs meeting the recommendation.
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Affiliation(s)
- Omoye E Imoisili
- Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Alyson B Goodman
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carrie A Dooyema
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Megan R Harrison
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brook Belay
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sohyun Park
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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15
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Morais A, Kelly J, Bost JE, Vaidya SS. Characteristics of Correctly Identified Pediatric Obesity and Overweight Status and Management in an Academic General Pediatric Clinic. Clin Pediatr (Phila) 2018. [PMID: 29514514 DOI: 10.1177/0009922818761891] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study identified and characterized the rates of documentation and guideline-based management of overweight and obese children within an academic pediatric clinic through a retrospective electronic medical record review of 7422 well-child visits in 2016. Diagnosis and treatment were analyzed by patient's weight diagnosis, sex, age, and provider training level. The percentages of correctly identified severely obese (90.2%), obese (77.0%), and overweight (42.0%) children were much higher than in previous retrospective chart reviews; however, less than 30% of children were referred for more intensive weight management to a dietitian or pediatric obesity weight management program. Increased provider training level was associated with a lower adherence to pediatric obesity guidelines. Strategic modifications to electronic medical records that automatically offer body mass index-associated weight diagnoses with a link to treatment pathways and resources are needed to facilitate improved compliance with current pediatric obesity guidelines in the primary care setting.
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Affiliation(s)
- Ana Morais
- 1 George Washington University, Washington, DC, USA
| | - Joseph Kelly
- 2 Children's National Health System, Washington, DC, USA
| | - James E Bost
- 2 Children's National Health System, Washington, DC, USA
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16
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Wright JA, Whiteley JA, Watson BL, Sheinfeld Gorin SN, Hayman LL. Tailored communications for obesity prevention in pediatric primary care: a feasibility study. HEALTH EDUCATION RESEARCH 2018; 33:14-25. [PMID: 29112721 PMCID: PMC6018684 DOI: 10.1093/her/cyx063] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 10/06/2017] [Indexed: 06/07/2023]
Abstract
Recommendations for the prevention of childhood obesity encourage providers to counsel parents and their children on healthy diet and activity behaviors. This study evaluated the feasibility of a theory-based, tailored communication intervention for obesity prevention (Team Up for Health) delivered during a well-child visit. A two-armed randomized controlled trial was used. Parents of children aged 4-10 years were recruited from a list of patients due for a well-child visit at a pediatric primary care clinic. Parents were randomized to either the 'immediate' condition (parent and pediatrician received the tailored report at the well-child visit) or the 'delayed' condition (parent received the report at the end of the study). Self-report measures assessed physical activity, fruits, vegetables, television time, sugary drinks, and 100% fruit juice. Parents completed assessments at baseline, <48 h and 4-week follow-up. Providers were interviewed at the end of the study. Independent t-tests were used to examine between group differences. Seven areas of feasibility were evaluated: Recruitment, randomization, measurement, retention, acceptability, implementation and demand. Results showed high rates of measurement (85%) and acceptability (89%) and implementation (80%) of the intervention. In conclusion, Team Up for Health was feasible; however, a larger study is needed to evaluate its efficacy.
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Affiliation(s)
- Julie A Wright
- Department of Exercise and Health Sciences, University of Massachusetts Boston, Boston, MA 02125, USA
| | - Jessica A Whiteley
- Department of Exercise and Health Sciences, University of Massachusetts Boston, Boston, MA 02125, USA
| | - Bonnie L Watson
- Department of Exercise and Health Sciences, University of Massachusetts Boston, Boston, MA 02125, USA
| | | | - Laura L Hayman
- Department of Nursing, University of Massachusetts Boston, Boston, MA 02125, USA
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17
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Reed M, Cygan H, Lui K, Mullen M. Identification, Prevention, and Management of Childhood Overweight and Obesity in a Pediatric Primary Care Center. Clin Pediatr (Phila) 2016; 55:860-6. [PMID: 26581352 DOI: 10.1177/0009922815614350] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background In the United States, overweight/obesity among youth has reached epidemic proportions. The purpose of this project was to (1) examine primary care provider adherence to American Academy of Pediatrics guidelines; (2) compare adherence based on patients' weight classification, age, race, and gender; and (3) identify areas for improvement in health care delivery. Methods A retrospective chart audit and feedback quality improvement project was conducted with a stratified random sample of 175 charts of 6- to 19-year-olds seen for well-child visits. Frequencies of provider adherence were reported. χ(2) Analyses of weight classification, age, race, or gender influence on adherence was calculated. Results After discussion with the primary care providers, 5 areas were identified as priorities for change (diagnosis based on BMI, parental history of obesity, sleep assessment, endocrine assessment, and attendance of patients at the follow-up visit). Conclusion Cost-efficient, feasible strategies to improve provider adherence to recommendations for identification, prevention and management of childhood overweight and obesity were identified.
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18
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Koebnick C, Mohan YD, Li X, Young DR. Secular Trends of Overweight and Obesity in Young Southern Californians 2008-2013. J Pediatr 2015; 167:1264-71.e2. [PMID: 26421485 DOI: 10.1016/j.jpeds.2015.08.039] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 07/21/2015] [Accepted: 08/14/2015] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To investigate secular trends in pediatric obesity in Southern California between 2008 and 2013. STUDY DESIGN In a population-based cohort study, measured weight and height were extracted from electronic health records of 1,331,931 patients aged 2-19 years who were enrolled in an integrated prepaid health plan between 2008 and 2013. Outcomes were the prevalence of overweight and obesity (body mass index-for-age ≥85th percentile). RESULTS The prevalence of obesity was 19.1% in 2008 and decreased by 1.6% (95% CI, 1.7%-1.5%) by 2013, corresponding to a relative decline of 8.4%. A significant decline was observed across all ages, sexes, races, and socioeconomic groups, but the magnitude of the decrease varied. The relative decline in obesity was stronger in boys (-9.3%) than in girls (-7.2%), in children aged 2-5 years (-15.4%) and 6-11 years (-11.8%) than in adolescents aged 12-19 years (-4.5%), and in whites (-12.6%) and Asians (-12.2%) than in Hispanics (-6.9%) and African Americans (-7.5%). CONCLUSION Secular trends from this large population-based cohort suggest that overweight and obesity in boys and girls are declining across age and racial/ethnic groups. However, the declines are less pronounced in adolescents compared with children, in girls, and in some minority groups. Programs addressing childhood obesity may need to be targeted.
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Affiliation(s)
- Corinna Koebnick
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.
| | - Yasmina D Mohan
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Xia Li
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Deborah R Young
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
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19
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Bronder KL, Dooyema CA, Onufrak SJ, Foltz JL. Electronic health records to support obesity-related patient care: Results from a survey of United States physicians. Prev Med 2015; 77:41-7. [PMID: 25952053 DOI: 10.1016/j.ypmed.2015.04.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 04/21/2015] [Accepted: 04/26/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Obesity-related electronic health record functions increase the rates of measuring Body Mass Index, diagnosing obesity, and providing obesity services. This study describes the prevalence of obesity-related electronic health record functions in clinical practice and analyzes characteristics associated with increased obesity-related electronic health record sophistication. METHODS Data were analyzed from DocStyles, a web-based panel survey administered to 1507 primary care providers practicing in the United States in June, 2013. Physicians were asked if their electronic health record has specific obesity-related functions. Logistical regression analyses identified characteristics associated with improved obesity-related electronic health record sophistication. RESULTS Of the 88% of providers with an electronic health record, 83% of electronic health records calculate Body Mass Index, 52% calculate pediatric Body Mass Index percentile, and 32% flag patients with abnormal Body Mass Index values. Only 36% provide obesity-related decision support and 17% suggest additional resources for obesity-related care. Characteristics associated with having a more sophisticated electronic health record include age ≤45years old, being a pediatrician or family practitioner, and practicing in a larger, outpatient practice. CONCLUSIONS Few electronic health records optimally supported physician's obesity-related clinical care. The low rates of obesity-related electronic health record functions currently in practice highlight areas to improve the clinical health information technology in primary care practice. More work can be done to develop, implement, and promote the effective utilization of obesity-related electronic health record functions to improve obesity treatment and prevention efforts.
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Affiliation(s)
- Kayla L Bronder
- The CDC Experience Applied Epidemiology Fellowship, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Carrie A Dooyema
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stephen J Onufrak
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer L Foltz
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA; United States Public Health Service Commissioned Corps, Atlanta, GA, USA
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20
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Welsh JA, Nelson JM, Walsh S, Sealer H, Palmer W, Vos MB. Brief training in patient-centered counseling for healthy weight management increases counseling self-efficacy and goal setting among pediatric primary care providers: results of a pilot program. Clin Pediatr (Phila) 2015; 54:425-9. [PMID: 25336443 DOI: 10.1177/0009922814553432] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We hypothesized that training in patient-centered counseling would improve self-efficacy and quality of weight management-related counseling provided by pediatric primary care physicians (PCPs). METHODS A total of 36 PCPs attended a brief (2-hour) training and consented to participate in an evaluation. Training impact was assessed using self-administered, pretraining and posttraining surveys and a review of patient charts from prior to and from 6 and 12 months after training for a random subsample of 19 PCPs (10 charts/timepoint per PCP). RESULTS Self-reported effectiveness at obesity prevention and treatment increased from 16.7% to 44.4% (P = .01) and from 19.4% to 55.6% (P < .001), respectively. Self-efficacy in counseling and motivating patients increased from 44.4% to 80.6% (P < .001) and 27.8% to 63.9% (P < .001), respectively. Goal documentation increased from 3.9% to 16.4% and 57.9% at 6 months and 12 months posttraining, respectively. CONCLUSIONS Brief training in patient-centered counseling appears to increase self-efficacy and the frequency and quality of weight-related counseling provided by PCPs.
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Affiliation(s)
- Jean A Welsh
- Children's Healthcare of Atlanta, Atlanta, GA, USA Emory University School of Medicine, Atlanta, GA, USA Nutrition and Health Sciences PhD Program, Emory University, Atlanta, GA, USA
| | | | - Stephanie Walsh
- Children's Healthcare of Atlanta, Atlanta, GA, USA Emory University School of Medicine, Atlanta, GA, USA
| | - Holly Sealer
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Wendy Palmer
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Miriam B Vos
- Children's Healthcare of Atlanta, Atlanta, GA, USA Emory University School of Medicine, Atlanta, GA, USA Nutrition and Health Sciences PhD Program, Emory University, Atlanta, GA, USA
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21
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Flood TL, Zhao YQ, Tomayko EJ, Tandias A, Carrel AL, Hanrahan LP. Electronic health records and community health surveillance of childhood obesity. Am J Prev Med 2015; 48:234-240. [PMID: 25599907 PMCID: PMC4435797 DOI: 10.1016/j.amepre.2014.10.020] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 10/27/2014] [Accepted: 10/28/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Childhood obesity remains a public health concern, and tracking local progress may require local surveillance systems. Electronic health record data may provide a cost-effective solution. PURPOSE To demonstrate the feasibility of estimating childhood obesity rates using de-identified electronic health records for the purpose of public health surveillance and health promotion. METHODS Data were extracted from the Public Health Information Exchange (PHINEX) database. PHINEX contains de-identified electronic health records from patients primarily in south central Wisconsin. Data on children and adolescents (aged 2-19 years, 2011-2012, n=93,130) were transformed in a two-step procedure that adjusted for missing data and weighted for a national population distribution. Weighted and adjusted obesity rates were compared to the 2011-2012 National Health and Nutrition Examination Survey (NHANES). Data were analyzed in 2014. RESULTS The weighted and adjusted obesity rate was 16.1% (95% CI=15.8, 16.4). Non-Hispanic white children and adolescents (11.8%, 95% CI=11.5, 12.1) had lower obesity rates compared to non-Hispanic black (22.0%, 95% CI=20.7, 23.2) and Hispanic (23.8%, 95% CI=22.4, 25.1) patients. Overall, electronic health record-derived point estimates were comparable to NHANES, revealing disparities from preschool onward. CONCLUSIONS Electronic health records that are weighted and adjusted to account for intrinsic bias may create an opportunity for comparing regional disparities with precision. In PHINEX patients, childhood obesity disparities were measurable from a young age, highlighting the need for early intervention for at-risk children. The electronic health record is a cost-effective, promising tool for local obesity prevention efforts.
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Affiliation(s)
- Tracy L Flood
- Departments of Population Health Sciences, University of Wisconsin School of Medicine and Public Health
| | - Ying-Qi Zhao
- Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health
| | - Emily J Tomayko
- Department of Nutritional Sciences, University of Wisconsin College of Agricultural and Life Sciences, Madison, Wisconsin
| | - Aman Tandias
- Family Medicine, University of Wisconsin School of Medicine and Public Health
| | - Aaron L Carrel
- Pediatrics, University of Wisconsin School of Medicine and Public Health
| | - Lawrence P Hanrahan
- Family Medicine, University of Wisconsin School of Medicine and Public Health.
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Higgins A, McCarville M, Kurowski J, McEwen S, Tanz RR. Diagnosis and Screening of Overweight and Obese Children in a Resident Continuity Clinic. Glob Pediatr Health 2014; 1:2333794X14559396. [PMID: 27335918 PMCID: PMC4804692 DOI: 10.1177/2333794x14559396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective. To evaluate the association between documenting excess weight and ordering screening tests. Methods. We retrospectively reviewed well-child visits for patients 2 to 18 years old at a pediatric resident clinic. We evaluated visits of patients with body mass index ≥ 85th percentile for documentation of excess weight in the electronic medical record (EMR) and screening tests ordered. Associations were investigated with χ2 tests. Results. Of 522 patients, 215 (41%) were overweight (19%) or obese (22%). Among obese and overweight patients, 92/215 (43%) had documentation of excess weight in the EMR. Screening tests were ordered for 39/92 (42%) patients with a diagnosis of excess weight versus 8/123 (6.5%) of those without one (P < .001). Conclusions. Documentation rates of excess weight by practitioners were low and worse for younger children and those with milder degrees of excess weight. Documenting excess weight in the EMR was highly associated with ordering of screening tests.
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Affiliation(s)
- Alanna Higgins
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Jacob Kurowski
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Scott McEwen
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Robert R Tanz
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Hirsch AG, Wood GC, Bailey-Davis L, Lent MR, Gerhard GS, Still CD. Collateral weight loss in children living with adult bariatric surgery patients: a case control study. Obesity (Silver Spring) 2014; 22:2224-9. [PMID: 24989939 PMCID: PMC4180803 DOI: 10.1002/oby.20827] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 06/13/2014] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To evaluate the impact of adult bariatric surgery on the body mass index (BMI) of children living in the same household. METHODS A retrospective case-control study. Case dyads (n = 128) were composed of one adult who had bariatric surgery and one child at the same address. Control dyads (n = 384) were composed of an adult with obesity but no bariatric surgery and a child at the same address. Two-sample t-test was used to determine whether the differences between actual and expected BMI at follow-up (post-surgery) differed between children in the case and control dyads. RESULTS Among boys who were overweight, boys who lived with a surgery patient had a lower than expected BMI post-surgery, while boys who did not live with a surgery patient had a higher than expected BMI at follow-up (P = 0.045). Differences between actual and expected BMIs of children were not significantly different between cases and controls in girls or in children in other weight classes. CONCLUSIONS Overweight boys who lived with an adult bariatric surgery patient had a lower than expected BMI after surgery as compared to controls. Future studies may be warranted to determine the mechanisms by which these children experience collateral weight loss.
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Affiliation(s)
| | - G. Craig Wood
- Geisinger Obesity Institute, Geisinger Health System
- Weis Center for Research, Geisinger Health System
| | | | | | - Glenn S. Gerhard
- Institute for Personalized Medicine, Penn State College of Medicine
| | - Christopher D. Still
- Geisinger Obesity Institute, Geisinger Health System
- Geisinger Center for Nutrition and Weight Management, Geisinger Health System
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24
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Tanda R, Salsberry P. The impact of the 2007 expert committee recommendations on childhood obesity preventive care in primary care settings in the United States. J Pediatr Health Care 2014; 28:241-50. [PMID: 23831376 PMCID: PMC3823635 DOI: 10.1016/j.pedhc.2013.05.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Revised: 05/15/2013] [Accepted: 05/29/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES In this study we examined the impact of the Expert Committee Recommendations (ECRs) on childhood obesity preventive care during well-child visits in the United States. METHODS Data from the 2006-2009 National Ambulatory Medical Care Survey and National Hospital Ambulatory Care Survey-outpatient department were used to examine frequencies of diet/nutrition and exercise counseling during well-child visits by children aged 2 to 18 years. Differences in rates of the counseling before and after the ECRs were made were compared. RESULTS Only 37% and 22% of all patients in 2006-2007 and 33% and 18% of all patients in 2008-2009 were provided with diet/nutrition and exercise counseling, respectively. The frequencies of counseling for patients with a diagnosis of obesity showed no change. Socioeconomically disadvantaged children received counseling less frequently after the ECRs were made. CONCLUSION Overall, rates of obesity preventive care were low in all years, with no evidence of improvement after the ECRs were made. Systematic approaches are needed to improve delivery of obesity preventive care irrespective of the socioeconomic backgrounds of children.
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Seibert TS, Allen DB, Carrel AL. Adolescent Obesity and Its Risks: How to Screen and When to Refer. JOURNAL OF CLINICAL OUTCOMES MANAGEMENT : JCOM 2014; 21:87-96. [PMID: 25892905 PMCID: PMC4399800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Tasa S Seibert
- Department of Pediatrics, University of Wisconsin, Madison, WI
| | - David B Allen
- Department of Pediatrics, University of Wisconsin, Madison, WI
| | - Aaron L Carrel
- Department of Pediatrics, University of Wisconsin, Madison, WI
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26
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Baer HJ, Cho I, Walmer RA, Bain PA, Bates DW. Using electronic health records to address overweight and obesity: a systematic review. Am J Prev Med 2013; 45:494-500. [PMID: 24050426 DOI: 10.1016/j.amepre.2013.05.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 04/12/2013] [Accepted: 05/22/2013] [Indexed: 11/30/2022]
Abstract
CONTEXT Overweight and obesity are problems of tremendous public health importance, but clinicians often fail to discuss weight management with their patients. Electronic health records (EHRs) have improved quality of care for some conditions and could be an effective mechanism for helping clinicians address overweight and obesity. This review sought to summarize current evidence on the use of EHRs for assessment and management of overweight and obesity. EVIDENCE ACQUISITION The authors searched PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Embase, Web of Science, CINAHL, INSPEC, IEEE Explore, and the ACM Digital Library from their inception through August 15, 2012; analyses were conducted between September 2012 and March 2013. Eligible studies had to involve a new feature or a change in an existing feature within an EHR related to the identification, evaluation, or management of overweight and obesity. Included in the review were RCTs and nonrandomized controlled trials, pre-post studies with a historical control group, and descriptive studies. One reviewer screened all of the titles and abstracts. Citations that were potentially eligible were independently reviewed by two reviewers. Disagreements were resolved by consensus. EVIDENCE SYNTHESIS Of the 1188 unique citations identified, 11 met the inclusion criteria. Seven of these studies were conducted in children and adolescents, and four were conducted in adults. Most of the studies were pre-post studies with a historical control group, and only three were RCTs. Most of the interventions included calculation, display, or plotting of BMI or BMI percentiles; fewer included other features. The majority of studies examined clinician performance outcomes; only two studies examined patient outcomes. CONCLUSIONS Few studies have examined whether EHR-based tools can help clinicians address overweight and obesity, and further studies are needed to examine the effects of EHR features on weight-related outcomes in patients.
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Affiliation(s)
- Heather J Baer
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (Baer, Cho, Bates), Boston, Massachusetts; Harvard Medical School (Baer, Cho, Bates), Boston, Massachusetts; Harvard School of Public Health (Baer, Bates), Boston, Massachusetts.
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Ayash CR, Simon SR, Marshall R, Kasper J, Chomitz V, Hacker K, Kleinman KP, Taveras EM. Evaluating the impact of point- of-care decision support tools in improving diagnosis of obese children in primary care. Obesity (Silver Spring) 2013; 21:576-82. [PMID: 23592666 DOI: 10.1002/oby.20161] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Revised: 08/09/2012] [Accepted: 10/29/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The purpose of this quasi-experimental study was to examine the effect of a computerized point-of-care alert with clinical decision support on the rates of diagnosis of childhood obesity in a multisite group practice in Massachusetts; Cambridge Health Alliance (CHA) which implemented an alert, relative to a separate group practice, Harvard Vanguard Medical Associates (HVMA), that did not. DESIGN AND METHODS Height and weight data from 19,466 children of 2-18 years with 34,908 well-child care visits in CHA and 123,446 children with 282,271 visits in HVMA between 2006 and 2008 were collected. The alert and decision support tool was activated for CHA patients with an age- and sex-specific body mass index of ≥95th percentile. The main outcome measure was documentation of an International Classification of Diseases, Ninth Revision [ICD-9] code for obesity before and after implementation of the alert at CHA in 2007. RESULTS Among obese children, the adjusted rate of an ICD-9 diagnosis of obesity increased from 2006-2007 to 2008 significantly more at CHA than at HVMA (P < 0.001 for time-by-provider group interaction). In 2006-2007, the rate of ICD-9 diagnosis of obesity was significantly lower at CHA than at HVMA (adjusted odds ratio [OR]: 0.57; 95% confidence interval [CI]: 0.52-0.62); but by 2008 was significantly higher at CHA than HVMA (adjusted OR: 1.25; 95% CI: 1.14-1.38). CONCLUSION A point-of-care alert was effective in improving obesity diagnosis in a multisite group practice, relative to a separate group practice that did not adopt an alert. Clinical decision support tools could help improve obesity diagnosis in pediatric primary care.
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Affiliation(s)
- Christine R Ayash
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
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Gee S, Chin D, Ackerson L, Woo D, Howell A. Prevalence of childhood and adolescent overweight and obesity from 2003 to 2010 in an integrated health care delivery system. J Obes 2013; 2013:417907. [PMID: 23970960 PMCID: PMC3732626 DOI: 10.1155/2013/417907] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 05/13/2013] [Accepted: 06/27/2013] [Indexed: 12/17/2022] Open
Abstract
An observational study of the Kaiser Permanente Northern California (KPNC) BMI coding distributions was conducted to ascertain the trends in overweight and obesity prevalence among KPNC members aged 2-19 between the periods of 2003-2005 and 2009-2010. A decrease in the prevalence of overweight (-11.1% change) and obesity (-3.6% change) and an increase in the prevalence of healthy weight (+2.7% change) were demonstrated. Children aged 2-5 had the greatest improvement in obesity prevalence (-11.5% change). Adolescents aged 12-19 were the only age group to not show a decrease in obesity prevalence. Of the racial and ethnic groups, Hispanics/Latinos had the highest prevalence of obesity across all age groups. The KPNC prevalence of overweight and obesity compares favorably to external benchmarks, although differences in methodologies limit our ability to draw conclusions. Physician counseling as well as weight management programs and sociodemographic factors may have contributed to the overall improvements in BMI in the KPNC population. Physician training, practice tools, automated BMI reminders and performance feedback improved the frequency and quality of physician counseling. BMI screening and counseling at urgent visits, in addition to well-child care visits, increased the reach and dose of physician counseling.
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Affiliation(s)
- Scott Gee
- Prevention & Health Information, Regional Health Education, The Permanente Medical Group, Inc., 1950 Franklin Street, 13th Floor, Oakland, CA 94612, USA.
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