Dissemination and Implementation of an Evidence-Based Pediatric Weight Management Program for Use by Low-Income Families: A User-Friendly Package of Family-Based Behavioral Treatment

传播和实施供低收入家庭使用的循证儿童体重管理计划：用户友好的家庭行为治疗方案

• 批准号: 9905454
• 负责人: Denise Ella Wilfley
• 金额: $ 74.96万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2021-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9905454
• 关键词: Dissemination; Implementation; Evidence; Based; Pediatric

Project Summary Family-based Behavioral Treatment (FBT) is an evidence-based pediatric weight management intervention (PWMI) that targets both child and parent. More than 30 years of research indicate that FBT reduces children’s percent overweight by almost 20%, with the average parent losing about 20 pounds during treatment. FBT also meets the US Preventive Services Task Force Recommendations as a comprehensive treatment for childhood obesity delivering more than 26 contact hours. The proposed project brings together a multi-sector team of collaborators, with expertise in behavioral science, community-based implementation science, pediatrics, technology, health services, and health economics. This multi-sector team will package and pilot test FBT for the treatment of pediatric obesity in two sites, representing both rural and urban settings, towards the goal of increasing access to this evidence-based, effective treatment among low-income families with children ages 5 to 12. First, training and treatment will be packaged for dissemination in a turn-key, technology- enhanced format (Aim 1). Given the lack of certified health care providers who can deliver FBT--which creates a major treatment barrier for low-income populations--we will develop the first online FBT training platform that includes FBT training materials for interventionists and treatment support materials for families. To inform this digital treatment package, we will incorporate feedback from a broad range of stakeholders, including representatives from local community-based organizations that serve low-income families, health care providers, local provider organizations, and members of the target populations. Once packaged, the intervention will be implemented in two distinct primary care settings (rural and urban; Aim 2). Primary care offers an optimal setting for FBT delivery, as it capitalizes on the established relationship between primary care providers and families. Co-locating interventionists within the primary care setting overcomes fragmentation of care and addresses provider time and referral barriers. Further, this delivery strategy dovetails with Missouri HealthNet Division’s recent state plan amendment which is scheduled to take effect in Missouri in 2019 to cover intensive obesity behavioral counseling and medical nutrition therapy for Medicaid patients, thus setting the stage for scaling FBT implementation across primary care. Implementation outcomes of the packaged intervention will be assessed at the organizational-level (Aim 2A) and patient-level (Aim 2B). Additionally, a scheduled Medicaid reimbursement mechanism will be evaluated as a promising method for sustainability and can serve as a model for other reimbursement mechanisms for private and public payers across the nation. Finally, the packaged treatment will be optimized based on data and feedback from the study, and community partners will be engaged to develop a sustainability and dissemination plan (Aim 3). Establishing that FBT can be implemented in real world settings is crucial to creating a system where children and their families affected by obesity can be effectively treated in centralized primary care settings.

项目摘要 基于家庭的行为治疗（FBT）是一种基于证据的小儿体重管理干预 （PWMI）针对子女和父母的。超过30年的研究表明FBT减少了儿童 超重的百分比增长了20％，在治疗期间，父母的平均体重减少了约20磅。也是FBT 满足美国预防服务工作队的建议，作为童年的全面治疗 肥胖提供26个以上的接触时间。拟议的项目汇集了一个多部门团队 合作者，具有行为科学专业知识，基于社区的实施科学，儿科， 技术，卫生服务和卫生经济学。这个多部门团队将包装和试点测试FBT 在两个地点的小儿肥胖症的治疗，代表粗糙和城市环境，目标 增加儿童5岁的低收入家庭中这种循证有效治疗的机会 到12。首先，将在旋转技术中包装培训和治疗以进行传播 - 增强格式（AIM 1）。鉴于缺乏可以提供FBT的认证医疗保健提供者 - 为低收入人群创建一个主要的治疗障碍 - 我们将开发第一个在线FBT培训 平台包括用于干预者的FBT培训材料和家庭的治疗支持材料。 为了告知这个数字处理套餐，我们将结合各种利益相关者的反馈， 包括来自当地社区组织的代表，这些组织为低收入家庭服务，健康 护理提供者，地方提供者组织和目标人群的成员。包装后， 干预将在两个不同的初级保健环境（农村和城市；目标2）中实施。基本的 护理为FBT提供了最佳的设置，因为它利用了主要的关系 护理提供者和家庭。在初级保健环境中共同解决干预者克服 护理的分裂并在提供者的时间和转介障碍物中解决。此外，这种交付策略索引 密苏里州Healthnet部门的最新州计划修正案计划在密苏里州生效 2019年涵盖医疗补助患者的密集肥胖行为咨询和医疗营养疗法，因此 为跨初级保健范围实施缩放FBT实施阶段。实施结果 包装干预措施将在组织级别（AIM 2A）和患者级别（AIM）进行评估 2b）。此外，将作为有前途的方法评估计划的医疗补助机制 为了可持续性，可以作为私人和公共付款人其他报销机制的模型 整个国家。最后，将根据数据和反馈来优化包装的处理 这项研究以及社区合作伙伴将参与制定可持续性和传播计划 （目标3）。确定可以在现实世界中实现FBT对于创建一个系统至关重要 可以在集中的初级保健环境中有效治疗受肥胖影响的儿童及其家人。