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.

项目概要美国 11 岁之前的儿童肥胖率仍处于历史高位，占所有儿童的 18%。在美国，26% 的西班牙裔儿童和 24% 的黑人儿童患有肥胖症。预防和治疗儿童肥胖的环境未得到充分利用。动机访谈（MI）是治疗儿童肥胖症以帮助患者参与和激励患者的一种治疗方法。最近成功的研究 BMI2（用于降低儿童体重指数的简短动机访谈）针对儿科护理实践中儿童的父母显着降低了基于 MI 的方法。对于少数种族/族裔和低收入人群尤其成功，但目标 MI 剂量。 BMI2 的实施需要大量资源，MI 课程由 PCP 和注册营养师管理。目前还不清楚 BMI2 的令人印象深刻的结果是否可以在现实世界的医疗保健系统中复制找到一种可行且可持续且无需条件的有效干预措施具有挑战性。我们的总体目标是减少初级保健儿童的体重过重。在南加州 Kaiser Permanente 的 36 家儿科诊所进行整群随机实用试验 (KPSC) 测试修改版 BMI2 干预措施在儿科诊所中的有效性（18 项干预措施， 18 个带注意力控制的常规护理，= 10,800 名儿童）诊所为超过 45,000 名 2-8 岁的儿童提供服务。超重或肥胖且种族/民族和社会经济高度多样化的人（53% 为西班牙裔；23% 为州裔）使用 MI 技术，PCP 将发起并维持有关体重的讨论与家长一起管理（6 x 20 分钟），并通过电子方式将患者转介给经验丰富且经过 MI 培训的生活方式教练可以完全访问 EMR，教练将致电转介家庭（孩子的年龄别体重指数≥85%）并通过电话 MI 咨询提供干预（6 x 45 分钟）。注意力控制将包括定期遭遇和教育视频作为注意力控制的主要目标：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（改良的 BMI2 方法）对 2 年随访时的 BMI 进行肥胖干预。调查少数族裔或低收入背景以及父母肥胖等患者特征如何改变 mBMI2Kids 干预的效果（影响的异质性）：这项研究有潜力。我们的研究结果将为儿科初级保健实践提供宝贵的指导。提供者和医疗保健系统帮助他们有效阻止和扭转儿童肥胖流行病。我们的结果可以快速转化为其他临床护理环境，并支持 EMR 的有意义使用使用工具和集中方法支持提供商的系统，使干预措施具有可扩展性。