Improving children's obesity-related health care quality: Process outcomes of a cluster-randomized controlled trial

Authors

  • Elsie M. Taveras,

    Corresponding author
    1. Division of General Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts, USA
    2. Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
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  • Richard Marshall,

    1. Department of Pediatrics, Harvard Vanguard Medical Associates, Boston, Massachusetts, USA
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  • Christine M. Horan,

    1. Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
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  • Matthew W. Gillman,

    1. Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
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  • Karen Hacker,

    1. Institute for Community Health, Department of Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts, USA
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  • Ken P. Kleinman,

    1. Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
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  • Renata Koziol,

    1. Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
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  • Sarah Price,

    1. Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
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  • Sheryl L. Rifas-Shiman,

    1. Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
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  • Steven R. Simon

    1. Section of General Internal Medicine, Veterans Affairs (VA) Boston Healthcare System, Boston, Massachusetts, USA
    2. Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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  • Funding agencies: American Recovery and Reinvestment Act (Award #R18 AE000026).Disclosures: The authors declare no conflict of interest.

  • Disclosures: The authors decla re no confli ct of interest.

  • Author Contributions: Study concept and design: Taveras EM, Kleinman K, Gillman MW, Hacker K, Marshall R, Simon SR; Acquisition of data: Horan, CM, Koziol R. Analysis and interpretation of data: Taveras EM, Rifas-Shiman SL, Kleinman K; Drafting of manuscript: Taveras EM, Rifas-Shiman SL; Critical revision of the manuscript for important intellectual content: Taveras EM, Rifas-Shiman SL, Kleinman K, Gillman MW, Hacker K, Marshall R, Horan CM, Price S, Koziol R, Simon SR; Statistical analysis: Rifas-Shiman SL, Kleinman KP; Obtained funding: Taveras EM; Marshall R; Administrative, technical, or material support: Horan CM, Price S, Koziol R; Study supervision: Taveras EM, Marshall R.

Abstract

Objective

To examine the extent to which an intervention using electronic decision support delivered to pediatricians at the point-of-care of obese children, with or without direct-to-parent outreach, improved health care quality measures for child obesity.

Design and Methods

Process outcomes from a three-arm, cluster-randomized trial from 14 pediatric practices in Massachusetts were reported. Participants were 549 children aged 6-12 years with body mass index (BMI) ≥ 95th percentile. In five practices (Intervention-1), pediatricians receive electronic decision support at the point-of-care. In five other practices (Intervention-2), pediatricians receive point-of-care decision support and parents receive information about their child's prior BMI before their scheduled visit. Four practices receive usual care. The main outcomes were Healthcare Effectiveness Data and Information Set (HEDIS) performance measures for child obesity: documentation of BMI percentile and use of counseling codes for nutrition or physical activity.

Results

Compared to the usual care condition, participants in Intervention-2, but not Intervention-1, had substantially higher odds of use of HEDIS codes for BMI percentile documentation (adjusted OR: 3.97; 95% CI: 1.92, 8.23) and higher prevalence of use of HEDIS codes for counseling for nutrition or physical activity (adjusted predicted prevalence 20.3% [95% CI 8.5, 41.2] for Intervention −2 vs. 0.0% [0.0, 2.0] for usual care).

Conclusion

An intervention that included both decision support for clinicians and outreach to parents resulted in improved health care quality measures for child obesity.

Ancillary