Implementation of Decision Support for the Management of Obesity in a National Pediatric Primary Care Research Network

在国家儿科初级保健研究网络中实施肥胖管理决策支持

基本信息

批准号：
10678630
负责人：
Mahnoosh Sharifi
金额：
$ 73.75万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-08-22 至 2025-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10678630
关键词：
12 year old Address Adolescent Adoption Adult Affect Attention Award Body mass index Cardiometabolic Disease Cardiovascular Diseases Child Childhood Clinical Informatics Clinical Trials Collection Consolidated Framework for Implementation Research Data Diabetes Mellitus Diagnosis Disparity Disparity population Dissemination and Implementation Educational Materials Effectiveness Effectiveness of Interventions Electronic Health Record Ethnic Origin Evaluation Geography Group Practice Health Health system Human Hybrids Indiana Intervention Low income Maintenance Malignant Neoplasms Massachusetts Mediating Methods Minority Modeling Obesity Obesity associated cancer Outcome Overweight Parents Patients Pediatric Hospitals Philadelphia Population Prevalence Primary Care Process Provider Psychology Public Health Qualitative Methods Quality of Care Quality of life Race Randomized, Controlled Trials Reach, Effectiveness, Adoption, Implementation, and Maintenance Recommendation Research Research Design Resources Risk Rural Sampling Site United States United States Preventative Services Task Force Universities Well in self Work Youth behavior change care delivery clinical care clinical decision support contextual factors data de-identification data warehouse demographics disparity reduction effective intervention effectiveness evaluation effectiveness outcome effectiveness/implementation study ethnic minority evidence base evidence based guidelines experience formative assessment future implementation high risk implementation efforts implementation evaluation implementation facilitation implementation facilitators implementation intervention implementation outcomes implementation science implementation strategy implementation tool improved minority children models and simulation mortality obesity in children obesity management obesity risk organizational readiness patient population pediatrician practice setting practice-based research network prevent primary care clinician primary care practice primary care setting racial minority recruit social socioeconomics theories tool trial design uptake urban disparity user centered design

项目摘要

PROJECT SUMMARY/ABSTRACT Nearly 1 in 3 children and adolescents – 23 million youth – in the United States are affected by overweight or obesity, and low-income, racial/ethnic minority and rural children are disproportionately impacted. Beyond the adverse impact of obesity on physical, social, and emotional wellbeing in childhood, children with obesity are at greater risk of obesity in adulthood, placing them at higher risk of obesity-related cancers, cardiometabolic disease, and early mortality. Despite guidance from the US Preventive Services Task Force and expert committees, pediatric primary care clinicians often do not follow available guidance for managing children with obesity. Electronic health records (EHRs) have the potential to improve clinicians' diagnosis and management of obesity by providing tools such as reminders and clinical decision support. We have demonstrated that an intervention package, consisting of EHR-based decision support for pediatricians and educational materials for parents, improved BMI among children in two clinical trials at a multisite group practice in Massachusetts. We have previously estimated, using a simulation model of the U.S. population, that high-fidelity dissemination and implementation of this intervention package among pediatric primary care practices with fully functional EHRs over 10 years has the potential to reach 2 million children with obesity and avert 43,000 cases of obesity at 10 years. However, little is known regarding the effectiveness of the intervention in various pediatric primary care settings, particularly those serving children from populations disproportionately impacted by obesity, or regarding the specific factors that influence the successful adoption and implementation of these tools. In partnership with a national practice-based research network, we aim to capitalize on advances in the field of Implementation Science to apply and evaluate this intervention for childhood obesity among a sample of 84 primary care practices affiliated with three health systems serving children with racial/ethnic, socio-economic, rural-urban, and geographic diversity. The scientific objectives of the proposed award are (1) to optimize a stakeholder-informed intervention and implementation package tailored to site-specific context among a national sample of participating practices, (2) to evaluate the impact of the intervention and implementation facilitation package in improving obesity-related care delivery and children’s BMI, and (3) to rigorously examine what works where and why among participating practice sites. To achieve these aims, we have assembled a transdisciplinary team with expertise is obesity, implementation science, clinical informatics, mixed methods, multi-site interventions, and user-centered design. We will apply a Hybrid Type 2 effectiveness-implementation study design wherein we will employ mixed methods in our formative and summative evaluation plan. To facilitate broad-scale dissemination in future implementation efforts, the results from this proposed study will provide invaluable evidence on the effectiveness of the intervention package and implementation facilitation strategy in settings serving populations most heavily burdened by obesity.

项目概要/摘要在美国，近三分之一的儿童和青少年（2300 万青少年）受到超重或肥胖的影响。肥胖、低收入、少数族裔和农村儿童受到的影响尤为严重。肥胖对儿童时期的身体、社会和情感健康产生不利影响，肥胖儿童成年后肥胖的风险更大，使他们患肥胖相关癌症、心脏代谢疾病的风险更高尽管有美国预防服务工作组和专家的指导，但疾病和早期死亡率。委员会、儿科初级保健机构往往不遵循现有的指导来管理儿童电子健康记录 (EHR) 有潜力改善老年人的诊断和管理。我们已经证明，通过提供提醒和临床决策支持等工具来控制肥胖。干预措施包，包括针对儿科医生的基于 EHR 的决策支持和针对儿科医生的教育材料我们在马萨诸塞州的一个多地点小组诊所进行的两项临床试验中，改善了儿童的体重指数。此前曾使用美国人口的模拟模型估计，高保真传播和在具有功能齐全的电子病历的儿科初级保健实践中实施这一干预措施 10年多的时间里，有可能惠及200万肥胖儿童，并在10岁时避免43,000例肥胖病例然而，人们对各种儿科初级保健干预措施的有效性知之甚少。环境，特别是那些来自受肥胖影响不成比例的人群的儿童，或有关影响这些工具成功采用和实施的具体因素。一个基于实践的国家研究网络，我们的目标是利用实施领域的进步在 84 个初级保健样本中应用和评估这种针对儿童肥胖的干预措施的科学与为不同种族/族裔、社会经济、农村和城市儿童提供服务的三个卫生系统相关的做法拟议奖项的科学目标是（1）优化利益相关者知情。根据国家样本中特定地点的情况量身定制的干预措施和实施方案参与实践，(2) 评估干预措施和实施促进方案的影响改善与肥胖相关的护理服务和儿童的体重指数，(3) 严格检查什么在哪里有效为什么在参与的实践地点中，为了实现这些目标，我们组建了一个跨学科团队专业知识是肥胖、实施科学、临床信息学、混合方法、多站点干预，以及以用户为中心的设计。我们将应用混合类型 2 有效性实施研究设计，因此我们将在我们的形成性和总结性评估计划中采用混合方法，以促进广泛传播。在未来的实施工作中，这项拟议研究的结果将提供宝贵的证据在服务人群的环境中一揽子干预措施和实施促进策略的有效性肥胖负担最重。