Health Information Technology to Support Clinical Decision Making in Obesity Care

As the rate of obesity has dramatic increased in youth, there has been an emergence of associated comorbidities such as dyslipidemia, hypertension, type 2 diabetes, musculoskeletal disorders, respiratory conditions, and emotional problems. In addition, as these youth become adults, they are at increased risks for cardiovascular disease and cancer. Guidelines exist for obesity prevention among youth; however, research has indicated that guidelines rarely change clinical practice and outcomes. For minority youth at risk for obesity and related chronic conditions, there are existing significant health disparities, creating additional barriers to robust obesity management.

The research team conducted a comparative effectiveness randomized clinical trial that evaluated the implementation of obesity prevention guidelines into school-based health centers (SBHCs) with the use of a system called HeartSmartKids™ (HSK). HSK was developed to facilitate the translation of recommendations into practice. SBHCs commonly provide primary care to minority underserved youth, and thus represent an ideal environment for such an intervention. The multilingual HSK provides a short, automated interview, generally completed via a kiosk while waiting for an appointment. The system collects data on health behaviors, motivations, feelings, and resources, subsequently generating printed outputs including growth charts, body mass index (BMI) percentile, and health risks including the child’s cardiovascular risk factors. HSK increases perception of risks by both patients and parents and provides suggestions regarding strategies for behavior changes. The outputs support providers by presenting them with a cardiovascular risk assessment for the child. Tailored recommendations provide both the provider and the family a starting point to have discussions of potential behavior changes.

The specific aims of the research were as follows:

• Evaluate the effectiveness of web-based training with and without computerized clinical decision support on providers' process and outcome behaviors related to implementing the current guidelines for prevention of obesity and related conditions.
• Explore the role of health information technology 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

The research established a virtual obesity collaborative in 24 SBHCs in six States. Two methods of training providers were compared: web-based guideline training, and web-based training plus clinical decision support with HSK. This latter group, referred to as the ‘technology group,’ was additionally given support via monthly phone calls, email, and telephone consultation with HSK staff.

Half the sites that were to use HSK successfully used the technology, while the other half had difficulty with implementation. Participants were highly satisfied with the virtual collaborative, and participation improved providers' adherence to obesity guidelines. Surveys indicated that the technology had a positive impact on parents' perception of their healthcare provider, as well as their ability to change their child’s diet and reports of less disrespectful staff. In addition, the technology group showed great improvements in chronic care model elements. The researchers noted the need for further evaluation of technology on patient outcomes.