Primary Care, Communication, & Improving Children's Health

初级保健、沟通、

• 批准号: 8787778
• 负责人: Christy Boling Turer
• 金额: $ 15.05万
• 依托单位: UT SOUTHWESTERN MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-01-01 至 2018-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8787778
• 关键词: 10 year old; 12 year old; Academy; Acanthosis Nigricans; Achievement; Address; Adherence; Adult; Advisory Committees; Age; American; Behavior; Behavioral; Blood Glucose; Blood Pressure; Body mass index; Cardiovascular system; Cessation of life; Child; Child health care; Childhood; Communication; Comorbidity; Competence; Computerized Medical Record; Control Groups; Counseling; Data; Data Analyses; Data Collection; Development; Diagnosis; Effectiveness; Effectiveness of Interventions; Elements; Enzymes; Family; Fasting; Future; Gender; Goals; Health; Heart Diseases; Height; ImProv; Indium; Intervention; Interview; K-Series Research Career Programs; Lead; Life Style; Lipids; Liver; Measures; Medical; Mentorship; Morbidity - disease rate; National Heart, Lung, and Blood Institute; Nutritionist; Obesity; Overweight; Parents; Participant; Patient Self-Report; Patients; Pediatrics; Physicians; Preventive; Primary Health Care; Protocols documentation; Provider; Public Health; Randomized Controlled Trials; Recommendation; Relative (related person); Research; Research Personnel; Research Priority; Research Training; Resources; Risk; Risk Behaviors; Risk Factors; Roter; Schedule; School-Age Population; Services; Specialist; Staging; Structure; Surveys; Techniques; Testing; Training Activity; Translating; United States; Video Recording; Visit; Weight; Weight maintenance regimen; base; behavior change; cardiovascular disorder risk; career development; clinical practice; design; effective intervention; evidence base; follow-up; healthy lifestyle; healthy weight; improved; interest; lifetime risk; longitudinal analysis; obesity in children; obesity management; obesity prevention; obesity treatment; pediatrician; premature; screening; skills; therapy development; working group

DESCRIPTION (provided by applicant): Childhood overweight is an important public-health problem in the US. Current estimates indicate that one in three children is overweight. Over half of overweight 5-10 year-old children have at least one cardiovascular disease risk factor, and overweight increases the lifetime risk of cardiovascular morbidity and premature death, but these risks are reduced in overweight children who attain a normal weight. During well-child visits, pediatricians have an opportunity to address weight and weight-management. Little is known, however, about clinical practice elements and pediatrician-patient communication strategies associated with weight improvement in overweight children. The overall objective of the proposed project is to identify specific clinical practice elements and pediatrician-patient communication strategies during well-child visits that predict improvement in relative weight among overweight children. This will be accomplished through three specific aims, which are to 1) identify specific clinical practice elements in pediatric primary care that predict improvement in weight status; 2) determine communication strategies that predict improvement in weight status; and 3) develop and test the feasibility and acceptability of a pilot intervention to improv pediatricians' communication and use of specific clinical practice elements when addressing weight and weight management during primary-care visits with overweight children. For Aim 1, electronic medical records (EMR) will be analyzed to determine clinical practice elements (such as lab assessments and follow-up interval) associated with improvement in weight status at one year follow-up. For Aim 2, Roter Interaction Analysis of video- recorded well-child visits will be used to analyze pediatrician-patient communication regarding weight and weight-management (including assessment and counseling regarding overweight status, and communication dynamics, including patient-centeredness), and children will be followed, by tracking interval visits, weights/heights, and referrals using the EMR, over one year. Findings from Aims 1 and 2 will be used in Aim 3 to develop and test the feasibility and acceptability of a pilot intervention aimed at improving pediatricians' observed and self-reported competence in using specific clinical practice elements and effective communication when addressing overweight during primary-care visits, compared with a control group of standard practice. The proposed Career Development Award addresses how to improve overweight/obesity management in primary care, a research priority of an NHLBI Working Group convened to set future research priorities in childhood obesity prevention and treatment. The exceptional resources and institutional support at UT Southwestern, outstanding multi-disciplinary mentorship team, and proposed career development activities will allow the candidate to achieve her long-term goal of becoming an independent investigator and nationally recognized expert on primary-care based interventions that are effective in improving childhood overweight and obesity.

描述（由申请人提供）：在美国，童年超重是一个重要的公共卫生问题。当前的估计表明，三分之一的孩子超重。超过一半的5-10岁儿童中，超过一半的患者至少有一个心血管疾病危险因素，并且超重增加了心血管发病率和过早死亡的终生风险，但是在达到正常体重的超重儿童中，这些风险会降低。在孩子探访期间，儿科医生有机会解决体重和体重管理。然而，关于临床实践要素和儿科医生沟通策略与超重儿童的体重改善相关的临床实践元素和儿科医生沟通策略知之甚少。拟议项目的总体目的是确定特定的临床实践要素和儿童访问期间的儿科医生沟通策略，以预测超重儿童相对体重的改善。这将通过三个特定目标来实现，即1）确定小儿初级保健中特定的临床实践要素，以预测体重状况的改善； 2）确定预测体重状况改善的沟通策略； 3）开发和测试试点干预措施的可行性和可接受性，以改善儿科医生的交流以及在与超重儿童的初级护理探访期间解决体重和体重管理时的特定临床实践要素。对于AIM 1，将分析电子病历（EMR），以确定与一年随访时体重状况改善相关的临床实践元素（例如实验室评估和随访间隔）。对于AIM 2，将使用视频记录的孩子访问的转子互动分析来分析有关体重和体重管理的儿科医生与患者的交流（包括有关超重状态的评估和咨询，以及沟通动态，包括以患者为中心的沟通动态），并通过跟踪间隔访问，体重/高度和转介仪，使用一年来跟踪间隔访问，重量/高度和转介。 AIM 1和2的发现将在AIM 3中用于开发和测试飞行员干预的可行性和可接受性 与标准练习的对照组相比，旨在改善儿科医生在使用特定的临床实践元素和有效沟通方面使用特定的临床实践元素和有效沟通方面的自我报告的能力。拟议的职业发展奖介绍了如何改善初级保健中的超重/肥胖管理，这是NHLBI工作组的研究优先级，旨在确定未来的肥胖症预防和治疗的研究优先级。 UT西南部，杰出的多学科指导团队以及拟议的职业发展活动的卓越资源和机构支持将使候选人实现她的长期目标，即成为一名独立的研究者和全国认可的基于初级保健的干预措施的专家，这些干预措施有效地改善了童年的超重和肥胖。