Clinical-Community Approaches to Pediatric Weight Management: MA CORD 2.0

儿科体重管理的临床社区方法：MA CORD 2.0

• 批准号: 9211020
• 负责人: Thomas Grover Land
• 金额: $ 147.75万
• 依托单位: MASSACHUSETTS STATE DEPT OF PUB HEALTH
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-06-01 至 2018-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9211020
• 关键词: Clinical; Community; Approaches; Pediatric; Weight

Project Summary Despite recent progress in obesity prevention, the prevalence of overweight and obesity in the US remains at historically high levels and racial/ethnic and socioeconomic disparities persist. Many factors contribute to the intractability of obesity but promising approaches for prevention and reduction are emerging including multi- sector, collaborative interventions across settings where children spend their time. Members of our research team at the Massachusetts Department of Public Health (MDPH) and the Massachusetts General Hospital have been at the forefront of innovation in childhood obesity prevention and management using clinical, community, and environmental approaches. We now seek to build on these innovative strategies to specifically optimize the care of low-income children with a body mass index (BMI) ≥ 85th percentile and in whom far greater energy deficits will be necessary to achieve improvements in BMI than those that can be achieved with community and environmental approaches alone. To achieve this goal, we propose a new clinical-community intervention, theoretically grounded in the Integrated Clinical and Community Systems of Care Model, to address obesity through optimized screening and management known to be effective in the STAR trial, e- Referrals developed by MDPH, Healthy Weight Clinics tested in the Massachusetts Childhood Obesity Research Demonstration project, and the YMCA's Healthy Weight and Your Child weight management program (originally known as MEND). We will aim to implement a model of high quality care for addressing overweight and obesity among 6-12 year old children that includes (a) computerized point-of-care decision supports to primary care providers to improve obesity screening and counseling; (b) educational materials and interactive text messages for self-guided behavior change support; (c) links to community resources to support behavior change; and (d) EHR-referral based, structured pediatric weight management. In a nested, randomized controlled trial we will also examine the comparative effects of a pediatric weight management program delivered in a Healthy Weight Clinic vs. the YMCA's Healthy Weight and Your Child program. Our study will examine outcomes for children that matter most to a broad group of stakeholders including parents, clinicians, and public health practitioners as well as inform the care of >7 million children with overweight or obesity covered by the Children's Health Insurance Program or Medicaid. To achieve these aims, we have assembled a multidisciplinary team with extensive expertise in implementation and evaluation of paradigm- shifting, clinical and community weight management programs as well as the use of health information technology to connect clinical delivery systems with community resources to improve health outcomes. Collaboration with Medicaid will ensure the sustainability of the program, which if successful, may provide a new model of obesity care for the very segment of the population who need it most.

项目摘要 尽管预防肥胖症最近取得了进展，但美国的超重和肥胖症的流行仍在 历史上高水平，种族/种族和社会经济差异持续存在。许多因素有助于 肥胖症的难治性，但有望预防和减少的承诺方法正在出现 行业，在孩子们度过时间的环境中进行的协作干预措施。我们的研究成员 马萨诸塞州公共卫生部（MDPH）和马萨诸塞州综合医院的团队 使用临床，在儿童肥胖预防和管理方面一直处于创新的最前沿， 社区和环境方法。我们现在寻求以这些创新的策略为基础 优化具有体重指数（BMI）≥85％的低收入儿童的护理 与可以通过 仅社区和环境方法。为了实现这一目标，我们提出了一个新的临床社区 干预，理论上基于综合的临床和社区护理模型， 通过优化的筛查和管理来解决肥胖症，已知在恒星试验中有效 由MDPH开发的推荐，在马萨诸塞州测试的健康体重诊所儿童肥胖症 研究演示项目以及基督教青年会的健康体重和您的子体重管理 程序（最初称为Mend）。我们将旨在实施高质量护理模型来解决 6-12岁的孩子的超重和肥胖包括（a）计算机点的决定 支持初级保健提供者改善肥胖症筛查和咨询； （b）教育材料和 自我引导行为变更支持的交互式文本消息； （c）链接到社区资源以支持 行为改变； （d）基于EHR的基于结构化的小儿体重管理。在嵌套 随机对照试验我们还将检查小儿体重管理的比较效果 在健康体重诊所与基督教青年会的健康体重和您的孩子计划中提供的计划。我们的 研究将研究对包括父母在内的一群利益相关者最重要的孩子的结果 临床医生和公共卫生从业人员，并为超重或超重儿童的护理提供信息 儿童健康保险计划或医疗补助涵盖的肥胖症。为了实现这些目标，我们有 组建了一个具有广泛专业知识的多学科团队，以实施和评估范式 转移，临床和社区体重管理计划以及健康信息的使用 将临床交付系统与社区资源联系起来以改善健康成果的技术。 与医疗补助的合作将确保该计划的可持续性，如果成功的话，可以提供 最需要它的人群的新肥胖护理模式。