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Quality Care for Obese Children | Journal Scan
Study Questions:
Does a computerized clinical decision support for pediatric clinicians with or without family lifestyle coaching improve body mass index (BMI) and quality of care for obese children?
Methods:
The Study of Technology to Accelerate Research (STAR) investigation was a cluster-randomized three-arm clinical trial, which enrolled children from 14 primary care practices in Massachusetts. Children were obese, defined as a BMI at the 95% percentile or higher for their age and gender. Enrollment occurred from October 2011 through June 2012. Participants were followed for up to 1 year. Five practices were randomized to clinical decision support where pediatric providers received decision support related to obesity management, while patients and families received an intervention for behavioral change. The decision support included a modification of the electronic health record to deploy a point of care alert when a well visit was scheduled for a child who met criteria for obesity. This alert included a link to growth charts and management guidelines. Options for coding of BMI percentile and nutritional and/or physical activity counseling were also provided. Providers were also trained in motivational counseling. A separate five practices received the same decision support and self-guided behavioral intervention, but also received individualized family coaching. Four other practices were randomized to usual care. The primary outcome of interest was change BMI and Healthcare Effectiveness Data and Information Set (HEDIS) performance measures for obesity.
Results:
A total of 549 children ages 6-12 years (mean age 9.8 years) were enrolled in the study. Mean BMI at baseline was 25.8. Compared to the usual care group, children in the clinical decision support group had less increase in BMI over the 1-year follow-up. Those in the clinical decision support and coaching arm had a smaller, but similar effect. Improvements in achievement of HEDIS measures were observed in the clinical decision support group providers and the clinical decision support with coaching providers compared to the control group providers.
Conclusions:
The investigators concluded that an intervention which included a clinical decision support, with support for behavioral change for children and families, improved BMI and quality of care.
Perspective:
It is interesting that the coaching did not add further improvement to the intervention. Interviewing families, children, and pediatric providers may assist in further refinement of this important intervention.
Keywords: Achievement, Body Mass Index, Child, Clinical Coding, Control Groups, Counseling, Diet, Electronic Health Records, Follow-Up Studies, Growth Charts, Life Style, Metabolic Syndrome, Motor Activity, Obesity, Primary Health Care, Primary Prevention, Self-Help Groups
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