Population Effects of Motivation Interviewing on Pediatric Obesity in Primary Care

动机访谈对初级保健儿童肥胖的人群影响

• 批准号: 9098302
• 负责人: Ken A. Resnicow
• 金额: $ 76.18万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-07-08 至 2021-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9098302
• 关键词: 8 year old; Academy; Address; Age; American; Behavior; Body mass index; Child; Clinic; Clinical; Communication; Counseling; Data; Dietitian; Disease Management; Dose; Education; Effectiveness; Electronic Health Record; Electronics; Family; Goals; Health Communication; Height; Intervention; Interview; Length; Link; Medical; Michigan; Modeling; Monitor; Motivation; Obesity; Online Systems; Overweight; Parents; Participant; Patients; Pattern; Pediatric Research; Pediatrics; Persons; Physicians; Population; Primary Health Care; Process; Race; Randomized; Records; Recruitment Activity; Research; Schedule; Site; System; Telephone; Testing; Text; Training; Universities; Weight; Youth; base; clinically significant; cohort; computerized data processing; effectiveness trial; efficacy testing; follow-up; group intervention; motivational enhancement therapy; obesity in children; patient population; primary outcome; programs; public health relevance; treatment as usual; treatment group; uptake

 DESCRIPTION (provided by applicant):We recently completed the BMI2 study, which tested the efficacy of two increasingly intensive interventions among overweight/obese youth ages 2-8 recruited from 39 practices in the American Academy of Pediatrics PROS network (Pediatric Research in Office Settings). Group 1 (Usual Care) was compared with treatment Groups 2 and 3 on BMI percentile at 2-year follow up. Group 2 comprised trained primary care practitioners (PCPs) who delivered 4 motivational interviewing (MI) sessions and Group 3, in addition to the 4 PCP MI sessions, had 6 MI sessions delivered by trained Registered Dietitians (RDs) linked with each practice. At two- year follow-up, the adjusted BMI percentile was 90.3, 88.1, and 87.1 for Usual Care, PCP only, and PCP + RD groups, respectively. The PCP + RD group mean was significantly lower than the UC group. A next logical step in our research is to test the populatio effect of the BMI intervention among all patients, when the intervention is delivered under more real world conditions. The proposed study will test the effectiveness of an enhanced version of the BMI2 intervention disseminated through 18 PROS practices (not participating in the BMI2 study). The primary aim will be to determine the impact of the intervention (change in BMI percentile) on the entire population of overweight and obese youth ages 3-10 in these 18 sites, based on shared Electronic Health Record data. We will pair-match and randomize all clinics to the either Usual Care or BMI2. For clinics assigned to BMI2, all PCPs will be trained in MI and the BMI2 intervention. To bring the intervention to scale, some key changes will be made to the intervention. First, despite the promising effects of BMI2, only 27% (37/141) of Group 3 participants were exposed to >=75% of the planned MI dose. This was due primarily to low completion of the RD counseling, only 2.7 out of 6 sessions were delivered. We will increase dose in several ways. First, we will add two-way tailored text messaging. Parents will receive 1-2 SMS per week, tailored to their family behaviors. In addition they will receive reminders for upcoming MI calls and reminders to schedule their child's assessments. We will implement the RD counseling through a centralized disease management system at our Center for Health Communications (CHCR). By centralizing the RD counseling at the U of M, we will be able to substantially increase the dose and quality of the RD intervention, and therefore increase intervention impact. Reach will be maximized by using trained office managers to approach all eligible families (child >85th percentile). The primary outcome is change in BMI z-score at two year followup. Secondary Hypothesis will explore BMI change among the subsample of youth exposed to the intervention. Exploratory Aims include quantifying revenue generated from obesity-related counseling at these clinics and compare revenue between the BMI2 and usual care clinics. The RE-AIM framework will guide analysis of reach, dissemination, and implementation in both the intervention and UC groups.

 描述（由适用提供）：我们最近完成了BMI2研究，该研究测试了从美国儿科职业学院（办公室环境中的儿科研究）中的39种实践中招募的超重/肥胖青年中两种日益密集的干预措施的效率。在2年随访时，将第1组（通常的护理）与BMI百分位数的第2和第3组进行了比较。第2组完成了受过训练的初级保健实践者（PCP），除了4次PCP MI会议外，还提供了4次激励性访谈（MI）会议（MI）会议（MI）会议（MI），还提供了6个MI会议，由训练有素的注册营养师（RDS）与每种练习相关联。在两年的随访中，调整后的BMI百分位数分别为90.3、88.1和87.1，分别用于通常的护理，仅PCP和PCP + RD组。 PCP + RD组平均值明显低于UC组。我们研究中的下一个合理步骤是，当干预措施在更真实的世界条件下进行时，所有患者在所有患者中的民众效应。拟议的研究将测试通过18种专业实践传播的增强版本的BMI2干预措施的有效性（不参加BMI2研究）。主要目的是根据共享的电子健康记录数据，确定在这18个地点中，在这18个地点中，干预措施（BMI百分位数的变化）对超重和肥胖年轻人的整个人群的影响。我们将配对并将所有诊所随机与常规护理或BMI2一起。对于分配给BMI2的诊所，所有PCP都将接受MI和BMI2干预的培训。为了扩展干预措施，将对干预进行一些关键更改。首先，dospite BMI2的有希望的影响，仅27％（37/141）的3组参与者暴露于计划中的MI剂量的75％。这主要是由于RD咨询的完成程度较低，在6次会议中只有2.7次。我们将以几种方式增加剂量。首先，我们将添加双向量身定制的文本消息传递。父母每周将获得1-2次SMS，并根据自己的家庭行为量身定制。此外，他们将收到有关即将到来的MI电话的提醒，并提醒您安排孩子的评估。我们将通过我们的卫生通信中心（CHCR）的集中疾病管理系统实施RD咨询。通过将RD咨询集中在M的U的U中，我们将能够大大提高RD干预的剂量和质量，从而增加干预影响。通过使用训练有素的办公室经理与所有合格的家庭（儿童> 85个百分位数），将最大程度地扩展到覆盖范围。主要结果是两年后随访时BMI Z得分的变化。次要假设将探索暴露于干预措施的青年子样本之间的BMI变化。探索性目的包括量化这些诊所与肥胖相关的cess养的收入，并比较BMI2和常规护理诊所之间的收入。 RE-AIM框架将指导干预和UC组中的覆盖范围，传播和实施分析。