Reducing Childhood Obesity through EHR-supported Motivational Interviewing

通过电子病历支持的动机访谈减少儿童肥胖

基本信息

批准号：
10579261
负责人：
Corinna Koebnick
金额：
$ 69.48万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-03-19 至 2026-02-28
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10579261
关键词：
11 year old Address Adopted Adoption Age Appointment Behavior Behavior Therapy Black race Body Weight Body mass index California Caring Cellular Phone Characteristics Child Childhood Clinic Clinical Communication Computerized Medical Record Counseling Dose Education Effectiveness Enrollment Ethnic Origin Family Friends Future Goals Healthcare Systems Heterogeneity Hispanic Individual Infrastructure Insurance Intervention Intervention Studies Investments Life Style Low Income Population Low income Maintenance Methods Minority Motivation Obesity Obesity Epidemic Overweight Parents Patients Persons Population Positioning Attribute Primary Care Provider Race Randomized Reach, Effectiveness, Adoption, Implementation, and Maintenance Recommendation Research Resources System Techniques Telephone Testing Text Time Training Translating Weight maintenance regimen aged attentional control behavior change clinical care dosage effective intervention effectiveness evaluation effectiveness testing efficacy study electronic medical record system ethnic minority evidence base experience follow-up health care settings motivational enhancement therapy nutrition obesity in children obesity treatment pragmatic randomized trial pragmatic trial prevent primary care practice primary care provider primary care setting racial minority response screening sex socioeconomic diversity telephone coaching tool treatment as usual virtual

项目摘要

Project Summary Rates of childhood obesity in the U.S. remain at historic highs. Before the age of 11 years, 18% of all children in the U.S. are already obese; 26% of Hispanic and 24% of Black children are obese. Pediatric primary care settings are underutilized in preventing and treating childhood obesity. An evidence-based method for treatment of childhood obesity to help engage and motivate patients is Motivational Interviewing (MI). One recent successful study, BMI2 (for Brief Motivational Interviewing to Reduce Child Body Mass Index) directed at the parents of children in pediatric care practices lowered BMI significantly. MI-based approaches have been particularly successful for racial/ethnic minorities and low-income populations. However, the targeted MI dose of BMI2 requires significant resources, with MI sessions administered by the PCP and a registered dietician. It is unclear whether the impressive results of BMI2 can be replicated in a health care system with real-world conditions. It is challenging to find an effective intervention that is feasible and sustainable without requiring significant resources. Our overall goal is to reduce excess body weight in children in primary care. We will conduct a cluster-randomized pragmatic trial in 36 pediatric clinics in Kaiser Permanente Southern California (KPSC) to test the effectiveness of a modified version of BMI2 intervention in pediatric clinics (18 intervention, 18 usual care with attention control, = 10,800 children). The clinics serve over 45,000 children aged 2-8 yrs who are overweight or obese with high racial/ethnic and socioeconomic diversity (53% Hispanic; 23% state- subsidized insurance). Using MI techniques, PCPs will initiate and maintain discussion about weight management with parent (6 x 20 min) and refer patients electronically to experienced and MI-trained lifestyle coaches. With full access to the EMR, coaches will call referred families (child’s BMI-for-age ≥85th percentile) and deliver intervention via telephonic MI counseling over two years (6 x 45 min). Usual care clinics with attention control will include regular encounters and educational videos as attention control. Primary Aim: Determine the effectiveness and dose-response relationship of a pragmatic, system-integrated childhood obesity intervention using mBMI2Kids (a modified BMI2 approach) on BMI at 2-yr follow-up. Secondary Aim: Investigate how patient characteristics such as minority or low-income background and parental obesity modify the effect of the mBMI2Kids intervention (Heterogeneity of effects). IMPACT: This study has the potential for a highly significant shift in pediatric primary care practices. Our results will provide valuable guidance to providers and health care systems to help them effectively halt and reverse the childhood obesity epidemic. Our results can be quickly translated into other clinical care settings and endorse the meaningful use of EMR systems to support providers using tools and centralized approaches that make interventions scalable.

项目摘要美国的儿童肥胖率仍然是历史悠久的高点。在11岁之前，所有儿童中有18％在美国已经肥胖了； 26％的西班牙裔和24％的黑人儿童肥胖。小儿初级保健在预防和治疗儿童对象方面的设置不足。一种基于证据的方法对儿童对象的治疗以帮助参与和激励患者是动机面试（MI）。一最近的成功研究BMI2（用于减少儿童体重指数的简短动机访谈）针对小儿护理习惯的儿童父母大大降低了BMI。基于MI的方法已经对于种族/族裔少数民族和低收入人群而言，特别是成功的。但是，靶向的MI剂量 BMI2需要大量资源，由PCP和注册营养师进行MI会议。它尚不清楚BMI2的令人印象深刻的结果是否可以在现实世界中的医疗保健系统中复制状况。在不需要的情况下找到可行和可持续的有效干预措施是挑战大量资源。我们的总体目标是减少初级保健儿童的体重过剩。我们将在Kaiser Permanente南加州的36个儿科诊所中进行集群随机务实试验（KPSC）测试BMI2干预版本在儿科诊所中的有效性（18个干预措施， 18常规护理，注意力控制，= 10,800名儿童）。该诊所为2 - 8年的45,000多名儿童提供服务超重或肥胖的种族/种族和社会经济多样性（53％的西班牙裔； 23％的国家）补贴保险）。使用MI技术，PCP将启动和维持有关体重的讨论与父母的管理（6 x 20分钟），并以电子方式将患者转介到经验和MI训练的生活方式教练。通过完全访问EMR，教练将致电推荐家庭（儿童的bmi-for-age≥85％）并在两年内通过电话MI咨询（6 x 45分钟）进行干预。通常的护理诊所注意控制将包括定期遭遇和教育视频作为注意力控制。主要目的：确定务实的，系统整合的童年的有效性和剂量反应关系使用MBMI2KIDS（一种修饰的BMI2方法）在2年随访时使用MBMI2KID（一种修饰的BMI2方法）。次要目标：研究少数族裔或低收入背景和父母肥胖等患者特征如何修改 MBMI2KIDS干预的影响（效应的异质性）。影响：这项研究有可能小儿初级保健实践的高度显着转变。我们的结果将为提供者和医疗保健系统有效地停止并扭转了儿童肥胖症的流行。我们的结果可以快速转化为其他临床护理环境，并认可有意义的EMR使用使用工具和集中式方法来支持提供商的系统，以使干预措施可扩展。