Improving Pediatric Obesity Practice Using Prompts

Not Applicable

Completed

Brief Summary: This study compares the effectiveness of electronic health record (EHR)-based tools to support the management of pediatric obesity in primary care. All clinicians will receive an interruptive "pop-up" alert We will examine the impact -- the added value versus unintended consequences -- of the interruptive alert on the quality of obesity management in pediatric primary care.

Detailed Description: The primary specific aims of this study are to:

1. To assess the impact of EHR-based tools for pediatric obesity in primary care. Hypotheses: EHR-based clinical decision support tools that interrupt but support clinical workflow will (1) improve measures of pediatric obesity care quality delivered by clinicians (e.g., addition of obesity to the problem list, recommended screening for comorbidities, and follow-up/referral plans) and (2) result in a reduced rate of BMI increase over one year among children with obesity.

2. To utilize a mixed methods approach with surveys and semi-structured qualitative interviews with clinicians to (1) examine the extent to which the EHR tools positively impact clinicians' awareness, knowledge and adherence to expert guidelines for pediatric obesity management, and (2) to explore the barriers to and facilitators of clinicians' use of the EHR tools and factors that influence adoption.

Recruitment & Eligibility

Inclusion Criteria

Not provided

Exclusion Criteria

Not provided

Arm && Interventions

Group	Intervention	Description
Interruptive Clinical Decision Support	Interruptive Clinical Decision Support	-

Primary Outcome Measures

Name	Time	Method
Change in proportion of patients with obesity	1-year pre-implementation compared to 1-year post-implementation	Change in proportion of patients with obesity who receive age-appropriate screening for comorbidities (blood measure measurement and age-appropriate laboratory screening)
Change in proportion of patients with obesity who have counseling for obesity-related behavior change documented in the EHR	1-year pre-implementation compared to 1-year post-implementation
Change in body mass index (BMI)	1 year pre-intervention, baseline, and 1 year post-intervention	change in BMI, calculated from height and weight measured as part of routine clinical practice during primary care clinic visits and documented in the EHR
Change in percent BMI above the 95th percentile (%BMIp95)	1 year pre-intervention, baseline, and 1 year post-intervention	Change in percentage of age/sex-adjusted BMI above the 95th percentile (%BMIp95), calculated from height and weight measured as part of routine clinical practice during primary care clinic visits and documented in the EHR
Change in documentation of elevated BMI diagnosis	1-year pre-implementation compared to 1-year post-implementation	Change in proportion of patients with obesity who have elevated BMI documented in the EHR
Change in proportion of patients with obesity with follow-up or referral orders	1-year pre-implementation compared to 1-year post-implementation

Secondary Outcome Measures

Name	Time	Method
Change in provider knowledge, attitudes and practice around obesity management in primary care assessed via an electronic surveys and qualitative interviews of clinicians	baseline compared to 6 months post-implementation
System usability scale (SUS) score	6 months post-implementation	the system usability scale is a validated 10-item measure of system usability

Locations (1): Boston Children's Hospital
🇺🇸
Boston, Massachusetts, United States

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