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（由申请人提供）：我们最近完成了 BMI2 研究，该研究测试了从美国儿科学会 PROS 网络（办公室环境中的儿科研究）的 39 个诊所招募的 2-8 岁超重/肥胖青少年中两种日益强化的干预措施的有效性第 1 组（常规护理）与第 2 组和第 3 组在 2 年随访时的 BMI 百分位数进行比较。他们进行了 4 次动机访谈 (MI) 课程，第 3 组除了 4 次 PCP MI 课程外，还接受了由经过培训的注册营养师 (RD) 与每次实践相关的 6 次 MI 课程。在两年调整后的随访中，BMI 得到了改善。常规护理组、仅 PCP 组和 PCP + RD 组的百分位数分别为 90.3、88.1 和 87.1。PCP + RD 组的平均值显着低于 UC 组。我们研究的下一个合乎逻辑的步骤是测试 BMI 干预在所有患者中的群体效应，该干预是在更真实的条件下进行的。拟议的研究将测试在 18 个人中传播的增强版 BMI2 干预的有效性。 PROS 实践（不参与 BMI2 研究）的主要目的是确定干预措施（BMI 百分位数的变化）对这 18 个地点 3-10 岁超重和肥胖青少年的影响。基于共享的电子健康记录数据，我们将把所有诊所配对并随机分配到普通护理或 BMI2。对于分配到 BMI2 的诊所，所有 PCP 将接受 MI 和 BMI2 干预培训。首先，尽管 BMI2 具有良好的效果，但第 3 组中只有 27% (37/141) 的参与者接受了 >=75% 的计划 MI 剂量。主要是由于 RD 咨询的完成率较低，我们将通过多种方式增加剂量。首先，我们将每周向家长发送 1-2 条短信。此外，他们还将收到有关即将到来的 MI 电话的提醒以及安排孩子评估的提醒。我们将通过我们的健康通讯中心 (CHCR) 的集中疾病管理系统来实施 RD 咨询。的大学M，我们将能够大幅增加 RD 干预的剂量和质量，因此通过使用经过培训的办公室管理人员接触所有符合条件的家庭（> 85% 的儿童），可以最大限度地提高干预影响。次要假设将探讨接受干预的青少年子样本的 BMI 变化，探索性目标包括量化这些诊所与肥胖相关的咨询所产生的收入，并比较不同诊所之间的收入。 BMI2 和常规护理诊所将指导干预组和 UC 组的覆盖范围、传播和实施分析。