Our Speakers Carrie Dooyema, Sarah Barlow, MD, MPH MSN, MPH, RN Behavioral Scientist, ECE Team, Division of Professor, Pediatrics, Department of Clinical Science, Nutrition, Physical Activity and Obesity UT Southwestern Medical Center Centers for Disease Control and Prevention, CDC Deanna Hoelscher, Nancy Butte PhD, RDN, LD, CNS, FISBNPA PhD Director, Michael & Susan Dell Center for Healthy Living Professor, Pediatrics-Nutrition Baylor College of Medicine John P. McGovern Professor in Health Promotion
Helping Our Nation’s Children Grow Up Strong & Healthy CDC’s Childhood Obesity Research Demonstration (CORD) 1.0 Projects Car arrie ie Doo ooyema, ema, MPH, H, MSN, N, RN N Beha ehavior ioral al Scient cientis ist and and Evalua aluator or Obes Obesit ity Prevent ention ion and and Cont ontrol ol Div ivis ision ion of of Nut Nutrit ition, ion, Phy hysical ical Act ctiv ivit ity, , and and Obes Obesit ity (DNP NPAO) O) COR ORD Team: eam: H. H. Blanc lanck, , B. . Belay elay, , A. . Goodman, Goodman, M. . Har Harris ison, on, S. . Gar Garner ner Fall all 2017 2017 Division of Nutri-on, Physical Ac-vity, and Obesity 3
DNPAO Strategic Priorities: Supporting All Americans Across the Lifespan Getting a Healthy Start • Breastfeeding • Early Child Nutrition Growing Up Strong & Healthy • Early Care and Education (ECE) and Schools (DPH) • Childhood Obesity Management Maintaining Good Nutrition • Healthy Food Environment • Vitamin & Mineral Malnutrition Keeping Active • Activity-Friendly Communities • Increasing Physical Activity
Childhood Obesity: Status and Impact Scope and Cost q 14.5% of low-income children (2014) aged 2-4 who are enrolled in WIC have obesity q 17.5% of children aged 6-11 years have obesity (2011-2014) – 5.6% of children aged 6-11 years have severe obesity q Obesity tracks from childhood to adulthood impacting both physical and mental health q Nearly 1 in 4 young adults are unfit or too heavy to serve in our military q Adult obesity costs an estimated $147-$190 billion per year in medical costs.
Childhood Obesity Recommendations § The NAM (IOM) recommends taking action in multiple settings Addressing where children learn, live & play childhood obesity requires § 2010 American Academy of a network of Pediatrics Practice Guidelines (2+) care between healthcare § In 2010 and 2017, the U.S. systems, public Preventive Services Task Force health, recommended that providers families, and screen children aged 6 years+ for the community obesity, and provide or refer to intensive lifestyle modification programs (Grade B)
Building the Foundation: CORD 1.0 Authorization Grantees: § Children’s Health Insurance Program § The University of Texas Reauthorization Act of 2009 Health Science Center at Houston § Required a multisectoral approach § San Diego State University Focus: Reduce Obesity by – § Massachusetts State Department of Public Parental-child behavioral management - Health o Increasing children’s physical activity, fruits, vegetables, and healthier beverages § The University of Houston served as the evaluation o Ensuring adequate sleep center for the project o Decreasing screen time and consumption of sugary drinks and energy-dense foods Target Audience § Low-income children aged 2-12 years in key settings (ECE, schools, community, healthcare)
CORD 1.0 Prevention and Treatment Model Collective Approach § Community Coalitions § Clinical-Community Linkages § Key organizations implement evidence based best practices (ECE, school, healthcare) Interventions in healthcare centers § Important setting to prevent child obesity § Improving screening, counseling and referral QI & Sustainability § CORD researchers: – Used clinical decision supports to aid in the provision of optimal care – Provided training & technical assistance providers – Provided a referral venue for children and families with obesity
22 publications, 3 toolkits For more informa-on, contact: Hblanck@cdc.gov For more information on CORD 1.0 visit our website at: https://www.cdc.gov/obesity/strategies/healthcare/cord1.html For more information on CORD 2.0 visit our website at: https://www.cdc.gov/obesity/strategies/healthcare/cord2.html The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
The Texas CORD Project: Recruitme ment nt s strategies a and nd outcome me f for w weight ht ma mana nageme ment nt n study comparison s 11/15/2017 Sarah E Barlow, MD, MPH UT Southwestern, Dallas TX Nancy F Butte, PhD Deanna Hoelscher, PhD Meliha Salahuddin, PhD Stephen Pont, MD, MS
�� ������������������� �� ����������������������� �� �������������������������� �� ����������������������� �� ����������������� �� ��������������� �� ���������� �������� �� ����������������� �� ���������������������������� �� ������������� �� ��������������������� �� ������������� �� ���������������� TX CORD Study Design CORD 1 0 Prevention PRIMARY HEALTH CARE CHILDCARE CENTERS l a r r GOV’T & PUBLIC POLICY e ELEMENTARY SCHOOLS f e R CORD 2 0 Prevention COMMUNITY HEALTH WORKERS COMMUNITY ORGS YMCA CENTERS COMMUNITY PROGRAMS Hoelscher et al., 2015
Office Selection 1. Catchments selected for household income, education, race and ethnicity Oluyomi et al., 2015 2. Healthcare offices selected for high Medicaid/CHIP eligible patients
Recruitme ment nt a and nd e enr nrollme llment nt a are p pre-r -requisites o of R RCT: : who ho d did ( (and nd w who ho d did no not) e enr nroll? ll? Intensive 0-3 mo Transi-on 3-12 mo Eligible pa-ents in prac-ces Referral MEND/CATCH to study Monthly Family Support YMCA 1.5 h /month Enrollment Randomiza9on OFFICE-BASED CARE Primary prevention tools available Frequency not prescribed Measures: Baseline 3 m 12 m
l structure Recruitme ment nt t the heoretical s Eligibility was limited to pa-ents in TX CORD Offices All pa-ents 2-12 years seen during recruitment BMI ≥ 85 th Referred Study enrollment
Practice-based support to encourage obesity care and study enrollment • Site: Primary healthcare clinics • Training: Physicians and support staff (in-person and online) • Components – Electronic health record (EHR) Best Practice Alert for Obesity/Overweight – EHR Obesity Smart Set – EHR referral link to study within Smart Set – Next Steps Guide & office materials for clinicians (Spanish & English) – Next Steps Booklet for families (Spanish & English) EHR changes adapted with permission: American Recovery and Reinvestment Act (Award #R18 AE000026) Taveras PI
Practices i in c n catchme hment nt a areas: : Houston: 5 practices from one large hospital network – 3 were structured as medical homes for low income patients, 2 had both commercial and public insurance – Common EHR – EHR alert and EHR referral implemented Austin: 7 practices from 3 parent organizations – Either FQHC or safety net clinics – 3 different administrations, 3 different EHRs – No EHR alert or EHR referral
Patients from TX CORD practices 2-12 y seen between 9/2012 and 1/2014 2-5 years 6-8 years 9-12 years n = 13155 n = 6737 n = 6868 Age years mean 3.58 7.24 10.8 Gender n (%) female 49.8 48.7 48.9 male 50.2 51.3 51.1 Race-ethnicity n (%) Hispanic 60.3 60.8 64.0 Black non-Hispanic 20.7 20.7 22.2 19.0 18.4 13.8 White non-Hispanic/Other Insurance type n (%) Medicaid 66.9 61.3 54.2 CHIP 6.8 13.1 13.8 Commercial 25.1 22.9 25.2 Other 1.1 2.8 6.8 BMI percen9le mean 55.0 65.8 70.3 BMI category n (%) <5th 7.8 3.3 2.7 5th - <85th 68.4 60.2 51.4 85th - <95th 12.6 15.1 18.7 95th - <99th 6.6 14.6 21.4 ≥99th 4.7 6.7 5.8
nt Recruitme ment 12 Offices: unique pa-ents 2-12 years of age seen between 9/2012 and 1/2014 All pa-ents 26,760 BMI ≥ 85 th “Referred” families 7,845 (29%) • heard about study AND Referred • agreed to Enrolled: 7% of pa-ents 2,124 (27%) receive more with BMI ≥ 85 th informa-on Enrolled 549 (26%)
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