| Conditions: |
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Childhood Overweight - Childhood Obesity |
| Purpose: |
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The purpose of this study is to address priority Research Area 3 in PAR-08-270: Health
information technology (HIT) to improve health care decision making through the use of
integrated data and knowledge management. The proposed study will evaluate the use of HIT
for clinician decision support and tailored patient education on the implementation of the
current guidelines for the prevention of obesity-related chronic conditions in health
disparity populations of poor, minority youth who access care through SBHCs. The specific
aims are:
1. To evaluate the effectiveness of web-based training with and without computerized
clinical decision support on provider's process and outcome behaviors related to
implementing the current guidelines for prevention of obesity and related conditions.
a. Process variables include the following: i. Provider knowledge, attitudes, and
barriers to implementing the guidelines. ii. Parent perception of the interpersonal
process of care (i.e., provider communication, collaborative decision making, and
interpersonal style).
iii. Parent perception of provider support for their child's healthy eating and
exercise.
b. Behavior outcomes include the following: i. Provider self-reported behaviors of
identification and assessment of overweight, counseling on nutrition and physical
activity, use of behavioral interventions, referrals, and cultural competency.
ii. Documentation by chart review of body mass index (BMI) percentile for age and sex;
appropriate diagnosis when BMI > 85th percentile; blood pressure (BP) percentile for
age, height, and sex; and ordering appropriate laboratory tests when indicated.
2. To explore the role of HIT in the processes of system change for implementation of the
guidelines for prevention of obesity and related conditions, including the
facilitators, barriers, and impact of the care model on change.
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| Study Summary: |
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The prevalence of overweight youth nearly quadrupled in the past four decades. An alarming
increase in the number of poor, underserved, overweight minority youth is reported. This
dramatic increase in overweight youth has led to the emergence of associated co-morbidities
such as dyslipidemia, hypertension, type 2 diabetes, musculoskeletal disorders, respiratory
conditions, and emotional problems in youth as well as increased risks of cardiovascular
disease and cancer as adults. School-based health centers (SBHCs) provide access to primary
care for many underserved and minority youth at risk for obesity and related chronic
conditions. Primary care providers (PCPs), however, including those at SBHCs, face a number
of barriers to addressing weight management in children. The rising prevalence of obesity
and difficulty in identifying, assessing, and maintaining healthy weight in children and
adolescents led national groups to convene expert panels that have published evidence-based
guidelines. These guidelines include screening for cardiovascular risk factors and using a
family-centered and culturally sensitive approach to care. The recommendations incorporate
the use of motivational interviewing (MI) and the chronic care model to collaborate with
families on a plan of care to improve children's health outcomes. The publication of
recommendations or guidelines, however, traditionally has not changed provider behavior.
Studies have shown widespread failure to follow established guidelines for a variety of
conditions. The barriers to implementing guidelines include inadequate tools or resources,
insufficient knowledge and skills, lack of self-efficacy, lack of time, and insufficient
reimbursement. Health information technology (HIT) serves as a mechanism for providing
decision support and tailored patient education materials to improve evidence-based care for
the prevention of obesity and related conditions. Self-efficacy regarding obesity counseling
has been linked to access to HIT. Other studies indicate that patients who received written
health information with graphics that depicted their response to therapy improved their
motivation to adhere to the treatment plan and were more satisfied with care. The proposed
study is a comparative-effectiveness trial evaluating the impact of web-based provider
training with and without HIT for provider decision support and tailored patient education.
The goal is to translate into practice the current evidence-based guidelines for the
prevention of obesity-related chronic conditions. HeartSmartKids™ is a decision-making tool
that integrates patient health information with evidence-based guidelines and generates
graphic trends of cardiovascular risks and tailored recommendations to improve patient
outcomes. Elimination of health disparities in the chronic conditions related to childhood
obesity depends upon the translation of best evidence into practice by the providers who
care to youth at-risk for these obesity-related conditions. The unique features of this
study are the SBHC setting; comparative effectiveness of web-based training on current
evidence-based recommendations with and without HIT to support providers' decision making
and tailored patient education; and the use of the Health Disparities Collaborative, the
Institute for Healthcare Improvement's Breakthrough Series quality improvement process, and
the chronic care model for childhood obesity for training providers on the current
guidelines.
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| Criteria: |
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Inclusion Criteria:
- School Based Health Centers who serve children 5-12 years
- sees a minimum of 20 children per month for well-child care or sports physicals
- has internet access and printer
- has space for a small computer in the waiting room or check-in area
- has a primary care provider who reads English.
Inclusion criteria for parents:
- read English or Spanish
Exclusion Criteria:
- centers that have implemented the HeartSmartKids program.
- children seen for immunizations, dental, or mental health care without a well-child
visit.
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| NCT ID: |
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NCT01281436 |
| Primary Contact: |
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Principal Investigator
Bonnie M Gance-Cleveland, Ph.D.
Arizona State University
Danielle M Dandreaux, Ph.D.
Phone: 480-496-0822
Email: danielle.dandreaux@asu.edu
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| Backup Contact: |
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Email: bonnie.gance-cleveland@asu.edu
Bonnie Gance-Cleveland, Ph.D., RNC, PNP, FAAN
Phone: 602-496-0908
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| Location Contact: |
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Phoenix, Arizona 85004
United States
Danielle Dandreaux, Ph.D.
Site Status: Recruiting |