Primary Care, Communication, & Improving Children's Health

初级保健、沟通、

基本信息

批准号：
8634477
负责人：
Christy Boling Turer
金额：
$ 14.84万
依托单位：
UT SOUTHWESTERN MEDICAL CENTER
依托单位国家：
美国
项目类别：
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/8634477
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 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 improved interest lifetime risk longitudinal analysis obesity in children obesity management obesity prevention obesity treatment pediatrician premature public health relevance screening skills therapy development working group

项目摘要

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）：儿童期超重是美国一个重要的公共卫生问题。目前的估计表明三分之一的儿童超重。超过一半的超重 5-10 岁儿童至少有一种心血管疾病危险因素，超重会增加终生心血管发病和过早死亡的风险，但体重达到正常的超重儿童的这些风险会降低。在儿童健康检查期间，儿科医生有机会解决体重和体重管理问题。然而，人们对与超重儿童体重改善相关的临床实践要素和儿科医生与患者的沟通策略知之甚少。该项目的总体目标是确定健康儿童就诊期间的具体临床实践要素和儿科医生与患者的沟通策略，以预测超重儿童相对体重的改善。这将通过三个具体目标来实现，即：1）确定儿科初级保健中预测体重状况改善的具体临床实践要素； 2）确定预测体重状况改善的沟通策略； 3) 制定并测试试点干预措施的可行性和可接受性，以改善儿科医生在超重儿童初级保健就诊期间解决体重和体重管理问题时的沟通和特定临床实践要素的使用。对于目标 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要素（例如实验室评估和随访间隔）。对于目标 2，将使用视频记录的健康儿童就诊的 Roter 交互分析来分析儿科医生与患者有关体重和体重管理的沟通（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），以及将通过跟踪间隔访问、体重/身高以及使用 EMR 转介来跟踪儿童一年多的时间。目标 1 和 2 的调查结果将用于目标 3，以开发和测试试点干预的可行性和可接受性旨在与标准实践对照组相比，提高儿科医生在初级保健就诊期间解决超重问题时使用特定临床实践要素和有效沟通的观察和自我报告能力。拟议的职业发展奖旨在解决如何改善初级保健中的超重/肥胖管理，这是 NHLBI 工作组的研究重点，该工作组旨在确定儿童肥胖预防和治疗的未来研究重点。德州大学西南医学中心的卓越资源和机构支持、杰出的多学科指导团队以及拟议的职业发展活动将使候选人能够实现其长期目标，成为一名独立研究者和全国公认的初级保健干预专家，这些干预措施是有效改善儿童超重和肥胖。