Health Information Technology to Support Clinical Decision Making in Obesity Care (Colorado)

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Summary:

Domestically, the prevalence of overweight youth has nearly quadrupled in the past four decades. This dramatic increase has led to the emergence of associated comorbidities such as dyslipidemia, hypertension, type 2 diabetes, musculoskeletal disorders, respiratory conditions, and emotional problems. In addition, there are increased risks of cardiovascular disease and cancer as these youth become adults.

The American Medical Association published recommendations and the National Association of Pediatric Nurse Practitioners developed family-centered, culturally sensitive, clinical practice guidelines for obesity prevention among youth. However, past research suggests that guidelines rarely change clinical practice and outcomes. Health information technology may provide a mechanism to better implement these guidelines via decision support and tailored patient education materials. Research is needed to evaluate the role of this technology in the clinical setting.

A computer support system for clinical decisionmaking and tailoring patient education called HeartSmartKids TM, has been developed to facilitate the translation of recommendations into practice. This current study will employ a comparative-effectiveness trial to evaluate clinician decision support and tailored patient education on the implementation of the current guidelines at school based health clinics. Outcome assessments will be conducted at the provider and system levels. The research aims to eliminate health disparities for the chronic conditions related to childhood obesity via the translation of best evidence-based guidelines into practice by the providers who care for youth at risk for these obesity-related conditions.

Health Information Technology to Support Clinical Decision Making in Obesity Care - 2012

Summary Highlights

  • Principal Investigator: 
  • Funding Mechanism: 
    PAR: HS08-270: Utilizing Health Information Technology to Improve Health Care Quality Grant (R18)
  • Grant Number: 
    R18 HS 018646
  • Project Period: 
    September 2010 – July 2013
  • AHRQ Funding Amount: 
    $496,977
  • PDF Version: 
    (PDF, 117.99 KB)

Summary: Domestically, the prevalence of overweight youth has nearly quadrupled in the past 4 decades. Accordingly, so have the comorbidities of obesity, which include dyslipidemia, hypertension, type 2 diabetes, musculoskeletal disorders, respiratory conditions, cardiovascular disease, and emotional problems.

The American Medical Association has published recommendations, and the National Association of Pediatric Nurse Practitioners has developed family-centered, culturally sensitive clinical practice guidelines for obesity prevention among youth. However, past research suggests that guidelines rarely change clinical practice or outcomes. Health information technology (IT) may provide a mechanism to improve implementation of these guidelines via decision support and tailored patient-education materials.

Dr. Bonnie Gance-Cleveland and her research team have developed HeartSmartKids, a computer support system for clinical decisionmaking and tailoring patient education to help translate recommendations into practice. This study is employing a comparative effectiveness trial to evaluate Web-based training with and without HeartSmartKids, technology decision support for the implementation of the current guidelines at school-based health clinics for children ages 5 to 12. Outcome assessments are conducted at the provider and system levels. The research aims to eliminate health disparities for the conditions related to childhood obesity via the translation of evidence-based guidelines into practice by the providers who care for youth who are at risk for these obesity-related conditions.

Specific Aims:

  • 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. (Ongoing)
  • Explore the role of health IT 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. (Ongoing)

2012 Activities: Site recruitment and institutional review board (IRB) approval was a major focus of the project in 2012. To date, the research team has recruited 23 sites in six States and IRB approval has been obtained for all of them. Thirteen sites were randomized to the technology arm and 10 to the control arm.

The data collection process requires three discrete steps: 1) a provider knowledge and self-report of behavior survey for each provider; 2) thirty-two chart audits at each site; and 3) thirty-two parent satisfaction surveys at each site. As of the end of 2012, surveys were completed by all providers, 663 chart reviews were conducted, and 250 parent surveys were completed. The parent surveys have been the most challenging aspect of data collection, as children are not always accompanied by parents at school-based clinics.

When baseline data collection was completed, iPads installed with the HeartSmartKids software were mailed to the clinics and providers were trained to use the system. The project team reported that some sites have old computers that were incompatible with Web-based training delivery and networks that did not support wireless needed for the iPads. Additionally, limited computer skills of staff were a barrier at a few sites. The research team, along with the HeartSmartKids staff and the IT support staff at the sites have worked to resolve these issues. Followup data collection will occur after the training and again at the end of the study.

An eLearning Web site for the Web-based training was previously developed and finalized. The purpose of the Web site is to teach providers about the program through four modules: 1) overview of recommendations; 2) motivational interviewing; 3) culturally sensitive care and community collaboration; and 4) sharing lessons learned. Weekly coaching calls were used to increase provider engagement in the study. The calls included a focus on plan-do-study-act cycles to guide providers through development and implementation in their clinics. The final module will conclude with a poster session at which the providers will present their project implementation progress in their clinics. Many of the provider projects focus on increasing identification of children who are overweight, obese, and/or hypertensive, the use of motivational interviewing, and education techniques to teach children about achieving healthier weights.

Due to challenges with site recruitment and IRB approval, Dr. Gance-Cleveland is using a 1-year no-cost extension. As last self-reported in the AHRQ Research Reporting System, the project is on track in some respects but not others. Progress is slightly behind schedule because several of the sites that originally committed to study participation dropped out due to staffing changes, budget cuts, or competing demands. Project spending is on track.

Preliminary Impact and Findings: Providers consistently rate their satisfaction with the HeartSmartKids intervention as good or very good. When asked what aspects of clinical practice they will change as a result of the training, responses included using more motivational interviewing to help families set realistic goals, and following the recommendation for repeat laboratory tests when clinically appropriate.

Target Population: Obesity, Pediatric*

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to improve health care decisionmaking through the use of integrated data and knowledge management.

Business Goal: Implementation and Use

*This target population is one of AHRQ’s priority populations.

Health Information Technology to Support Clinical Decision Making in Obesity Care - 2011

Summary Highlights

  • Principal Investigator: 
  • Funding Mechanism: 
    PAR: HS08-270: Utilizing Health Information Technology (IT) to Improve Health Care Quality (R18)
  • Grant Number: 
    R18 HS 018646
  • Project Period: 
    September 2010 - July 2013
  • AHRQ Funding Amount: 
    $496,977
  • PDF Version: 
    (PDF, 197.55 KB)

Summary: Domestically, the prevalence of overweight youth has nearly quadrupled in the past four decades. This dramatic increase has led to the emergence of associated comorbidities such as dyslipidemia, hypertension, type 2 diabetes, musculoskeletal disorders, respiratory conditions, and emotional problems. In addition, there are increased risks of cardiovascular disease and cancer as these youth become adults.

The American Medical Association has published recommendations, and the National Association of Pediatric Nurse Practitioners has developed family-centered, culturally-sensitive clinical practice guidelines for obesity prevention among youth. However, past research suggests that guidelines rarely change clinical practice and outcomes. Health information technology (IT) may provide a mechanism to better implement these guidelines via decision support and tailored patient education materials.

Dr. Bonnie Gance-Cleveland and her research team have developed HeartSmartKidsTM, a computer support system for clinical decisionmaking and tailoring patient education to facilitate the translation of recommendations into practice. This study is employing a comparative effectiveness trial to evaluate HeartSmartKids with and without technology decision support on the implementation of the current guidelines at school-based health clinics for children ages 5 to 12. Outcome assessments will be conducted at the provider and system levels. The research aims to eliminate health disparities for the conditions related to childhood obesity via the translation of evidence-based guidelines into practice by the providers who care for youth at risk for these obesity-related conditions.

Specific Aims:

  • 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. (Ongoing)
  • Explore the role of health IT 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. (Upcoming)

2011 Activities: Site recruitment and institutional review board (IRB) approval was a major focus of the project in 2011. To date, the research team has recruited 24 sites in six states. IRB approval has been obtained for 22 of the sites. Some of the sites accepted Arizona State University's (ASU's) IRB approval, while others required separate protocols. Among sites that did not accept ASU's IRB approval, some sites required one protocol while others required two protocols, one for the parent organization and the other for the school district. In total, the project team wrote 17 IRB protocols. Of sites with IRB approval, 11 sites with 11 providers were randomized to the technology intervention arm, and the other 11 sites with 13 providers were randomized to the nontechnology control arm. Several of the sites that originally committed to study participation dropped out due to staffing changes, budget cuts, or competing demands. As a result, the project team will recruit two additional sites in 2012.

As IRB approval was received for each site, the study team initiated baseline data collection. This data collection process requires three discrete steps: 1) a provider satisfaction survey for each provider; 2) 32 chart audits at each site; and 3) 32 parent satisfaction surveys at each site. As of the end of 2011, surveys were completed by 22 providers, chart reviews were completed at 16 sites, and a number of parent surveys were completed at 10 of the sites. The parent surveys have been found to be the most challenging aspect of data collection, as children are not always accompanied by their parents at school-based clinics.

When baseline data collection is complete, iPads with the HeartSmartKids software will be mailed to the clinics. Providers are then trained to use the system. Of the six sites that have received the technology, five have installed the software. The project team reported that some sites have old computers that resulted in compatibility issues. Additionally, the computer skills of the staff were a barrier at a few sites. The HeartSmartKids staff and the IT support staff at the sites have worked closely to resolve these issues. Followup data collection will occur after the training and again at the end of the study.

An eLearning Web site for the Web-based training was developed and finalized. The purpose of the Web site is to teach providers about the program through four modules: 1) overview of recommendations; 2) motivational interviewing; 3) culturally-sensitive care and community collaboration; and 4) sharing lessons learned.

As last self-reported in the AHRQ Research Reporting System, the project is on track in some respects but not others. Progress is slightly behind schedule due to difficulties recruiting and retaining sites. Project spending is on target.

Preliminary Impact and Findings: Among providers who have begun the training, providers rated their satisfaction as good or very good. When asked what aspects of clinical practice they will change as a result of the training, responses included using more motivational interviewing to help families set realistic goals and following the recommendation for repeat laboratory tests when clinically appropriate.

Target Population: Obesity, Pediatric*

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to improve health care decisionmaking through the use of integrated data and knowledge management.

Business Goal: Implementation and Use

* This target population is one of AHRQ's priority populations.

Health Information Technology to Support Clinical Decision Making in Obesity Care - 2010

Summary Highlights

  • Principal Investigator: 
  • Funding Mechanism: 
    PAR: HS08-270: Utilizing Health Information Technology (IT) to Improve Health Care Quality (R18)
  • Grant Number: 
    R18 HS 018646
  • Project Period: 
    September 2010 – July 2013
  • AHRQ Funding Amount: 
    $496,977
  • PDF Version: 
    (PDF, 320.46 KB)


Target Population: Obesity, Pediatric*

Summary: Domestically, the prevalence of overweight youth has nearly quadrupled in the past four decades. This dramatic increase has led to the emergence of associated comorbidities such as dyslipidemia, hypertension, type 2 diabetes, musculoskeletal disorders, respiratory conditions, and emotional problems. In addition, there are increased risks of cardiovascular disease and cancer as these youth become adults.

The American Medical Association has published recommendations and the National Association of Pediatric Nurse Practitioners has developed family-centered, culturally sensitive, clinical practice guidelines for obesity prevention among youth. However, past research suggests that guidelines rarely change clinical practice and outcomes. Health information technology (IT) may provide a mechanism to better implement these guidelines via decision support and tailored patient education materials. Research is needed to evaluate the role of this technology in the clinical setting.

HeartSmartKids™, a computer support system for clinical decisionmaking and tailoring patient education, has been developed to facilitate the translation of recommendations into practice. This study will employ a comparative-effectiveness trial to evaluate clinician decision support and tailored patient education on the implementation of the current guidelines at school based health clinics. Outcome assessments will be conducted at the provider and system levels. The research aims to eliminate health disparities for the conditions related to childhood obesity via the translation of evidence-based guidelines into practice by the providers who care for youth at risk for these obesity-related conditions.

Specific Aims:
  • 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. (Upcoming)
  • Explore the role of health IT 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. (Upcoming)

2010 Activities: During the grant’s first quarter, efforts have predominately focused on start-up activities including hiring new staff, recruiting clinics, and developing online modules. Twenty-four clinics were recruited for study participation and institutional review board protocols are being developed for each of these sites.

Grantee's Most Recent Self-Reported Quarterly Status (as of December 2010): Overall the project is making progress and meeting most of its aims and milestones. There is a viable plan for achieving other milestones. The project is slightly under-spent due to late distribution of funds.

Preliminary Impact and Findings: This project has no preliminary findings to date.

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to improve health care decisionmaking through the use of integrated data and knowledge management.

Business Goal: Implementation and Use

*AHRQ Priority Population.

Health Information Technology to Support Clinical Decision Making in Obesity Care - Final Report

Citation:
Gance-Cleveland B. Health Information Technology to Support Clinical Decision Making in Obesity Care - Final Report. (Prepared by the University of Colorado, Denver under Grant No. R18 HS018646). Rockville, MD: Agency for Healthcare Research and Quality, 2014. (PDF, 725.45 KB)

The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. (Persons using assistive technology may not be able to fully access information in this report. For assistance, please contact Corey Mackison)
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