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Accelerating Adoption of Childhood Obesity Comparative Effectiveness Research


Childhood obesity is highly prevalent and is associated with both short- and long-term adverse outcomes. In recognition of the public health importance of childhood obesity, the American Medical Association, the Health Resources and Services Administration, and the Centers for Disease Control and Prevention released Expert Committee Recommendations on the Assessment, Prevention, and Treatment of Child and Adolescent Overweight and Obesity in 2007, a revision of guidelines originally issued in 1998. In 2009, the National Committee for Quality Assurance released new nationally standardized performance measures (Health Plan and Employer Data and Information Set [HEDIS]), focused on improving quality of care for obesity in children. Most recently in 2010, The United States Preventive Service Task Force recommended screening for obesity in children and adolescents as young as 6 years of age, further highlighting the wide-reaching importance of this clinical and public health issue. Despite availability of guidelines for nearly a decade and more recent comparative effectiveness research (CER) evidence, the health care system has been slow to adopt recommended practices. Although pediatric health care providers often cite barriers such as limited time, skill, and resources, a frequently overlooked barrier is the lack of data systems to efficiently and accurately assess guideline implementation and to improve quality of care for childhood obesity. Health information technology (HIT) offers potential for accelerating the adoption of CER evidence regarding childhood obesity screening and management, for establishing treatment benchmarks, and for supporting patients and their clinical teams in care improvement. Incorporation of HIT may be especially effective if augmented by outreach to parents and children. The purpose of this study is to develop and test, in a cluster-randomized controlled trial, two systematic strategies for adoption of childhood obesity CER evidence. The first incorporates computerized point-of-care decision alerts to pediatric primary care providers during routine office visits, linked to CER-based algorithms of care. The second augments this HIT approach with direct-to-parent communication of child's body mass index (BMI) along with recommended evaluation and management. The target population is children ages 6 to 12 years with a BMI e 95th percentile. Outcome measures will include 1) point-of-care measures demonstrating adherence to CER-based screening guidelines, 2) BMI and obesity-related behaviors at 1-year post enrollment, and 3) cost and cost effectiveness of each intervention arm. We will also develop a detailed dissemination guide to further accelerate adoption of CER evidence on childhood obesity in practices and communities interested in implementing similar interventions. To achieve our aims, we have assembled a research team with extensive experience in obesity prevention, clinician and child behavior change, clinical informatics, statistical methodology in cluster randomized controlled trials, cost-effectiveness analyses, and dissemination science. If successful, this project will provide new and sustainable approaches for accelerating adoption of CER evidence for childhood obesity screening and management and for improving quality of care for childhood obesity in pediatric primary care.

PUBLIC HEALTH RELEVANCE: Childhood obesity is prevalent and of consequence. Despite availability of comparative effectiveness research (CER) evidence, the health care system has been slow to adopt recommended practices for management of childhood obesity. The goal of this study is to develop and test system-level interventions to accelerate the adoption of CER evidence on childhood obesity screening and management and ultimately improve obesity- related health care quality and outcomes in the private and public sector.


Funded by the NIH National Center for Advancing Translational Sciences through its Clinical and Translational Science Awards Program, grant number UL1TR002541.