Dissemination and Implementation of the Connect for Health Pediatric Weight Management Program Meg Simione, PhD Holly Frost, MD Elsie M. Taveras, MD, MPH Project Director Clinician Champion Principal Investigator @megsimione @elsiemt September 20, 2019
Meg Simione, PhD • Has nothing to disclose. 2
Holly Frost, MD • Has nothing to disclose. 3
Connect for Health Pediatric Weight Management Program • A proven effective, multilevel intervention • To improve childhood obesity screening, management, and body mass index (BMI) • Clinician and family-facing tools 4
Connect for Health Randomized trial 2-12 year-olds with overweight or obesity 6 pediatric offices in MA 721 children 1 year duration Intervention Components: • Electronic decision support; • Behavior change materials; • Text messaging; • Neighborhood resources; • Health Coaching Outcomes: • Changes in BMI z-score • Child quality of life • Behavioral change 5
Connect for Health Bundle Family materials • Educational materials to Drink water. support behavior Have 0 sugary change self- Make sleep a priority. drinks. management; Stick to regular bedtime and wake Boston Natural Areas Network • Text messages; times for your child. Free guided walks, hikes, rock • Connections to climbing, and canoe & bicycle trips resources. 6
Connect for Health Bundle Electronic health record (EHR) tools for clinicians • Flagging of children with BMI ≥ 95 th percentile; • Clinical decision support tools to guide screening and management; • Provider training. 7
Implementation Sites • Pediatric primary care practices in three healthcare systems that serve a diverse patient population 6 practices 9 practices 7 practices 8
Optimizing and Adapting Connect for Health • Clinician interviews • Preliminary findings & parent surveys • Clinicians wanted • Assessed needs, resources to address pediatric weight perspectives, management and preferences, and preferred tools that barriers and were culturally facilitators to appropriate and program uptake enhanced patient care without disrupting workflow 9
Optimizing and Adapting Connect for Health • Customizing the program • EHR tools • Clinician training • Patient educational materials and text messaging program • Community based resources 10
Engagement of Key Stakeholders • Meetings with key stakeholders • Family Advisory Council • Community Advisory Council • Community-Based Board of Director meetings • Child Health & Advocacy Professional Advisory Council • Pediatric Quality Improvement Committees • Primary Care Medical Directors meeting • Unit Chief meetings • Medical Assistant Council 11
Implementation Strategies • EHR screening and clinical decision support tools • Clinician champions and Strategies to practice coaches for “at Strategies to increase support integration the elbow support” knowledge into practice • In-person trainings • Tutorials and manuals • Virtual learning communities 12
Evaluation Patient-centered outcomes Outcome Source Parent’s experiences Parent surveys using the with care Patient Assessment of Chronic Illness Care Changes in child BMI BMI from EHR 13
Evaluation Implementation outcomes Outcome Definition Source Reach How many children will receive this program? HEDIS* measures Adoption How many clinicians and parents use the EHR tool audits; text program tools? messaging audits Fidelity What is the adherence to the intended Clinician interviews and program? observations Appropriateness What is the perceived fit of the program? Clinician interviews Maintenance How is the program sustained after the study EHR tool audits period is over? *Healthcare Effectiveness Data and Information Set 14
Lessons Learned & Key Take-Aways • Being responsive to the needs of clinicians, staff, and families is essential – stakeholders at all sites want to be involved in the decision-making process • Workflows and EHR builds vary greatly across healthcare systems – customizing for sites is key • A staggered roll-out allows for minor modifications and adjustments 15
Learn More • www.pcori.org • info@pcori.org • #PCORI2019 • www.c4hprogram.com 16
Questions? 17
Thank You! Holly Frost, MD Meg Simione, PhD Elsie Taveras, MD, MPH Project Director Clinician Champion Principal Investigator @megsimione @elsiemt 18
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