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Faithfully following an obesity intervention program that included computerized clinical decision support for physicians and health coaching for families yielded improvements in BMI in children, according to new study data.
In a study published in JAMA Pediatrics, Elsie M. Taveras, MD, MPH, of Massachusetts General Hospital for Children in Boston, and colleagues note the shocking prevalence of childhood obesity and the fact that management strategies have often not been effective in improving children’s BMI in the primary care setting.
“An important barrier to improving obesity management has been the lack of robust clinical information systems to improve the quality of care. The use of electronic health records offers the potential for improving the quality of care for obese children and for accelerating the use of evidence on obesity screening and management practices by primary care clinicians,” they wrote, adding that incorporating outreach to parents and children may further strengthen the efficacy of this approach.
To examine the efficacy of an intervention using clinical decision support delivered to pediatric clinicians at the point of care of children with obesity, Taveras and colleagues conducted a three-arm clinical trial. Participants included 549 children aged 6 to 12 years with BMIs in at least the 95th percentile from 14 primary care practices from October 2011 to June 2012. Average age at baseline was 9.8 years, and average BMI at baseline was 25.8.
For the study, the researchers assigned five practices (n=194) to clinical decision support tools where the existing EHR was modified to alert pediatricians to a child with a high BMI and provide links to growth charts, obesity screening guidelines and referrals for weight management programs. Educational materials and follow-up visits focused on behavior change such as drinking less sugary beverages and increasing physical activity and sleep.
In another five practices, (n=171), the intervention included a health coach assigned to work with families via phone, text message and email in addition to the clinical decision support tools.
In four practices (n=184), participants received usual care, which was the standard care offered by the current pediatric office with no clinical decision support tools for obesity management.
After 1 year, the different interventions appeared to have different effects on BMI over time (P=.04), according to the data.
BMI increased less among children in the clinical decision support arm during 1 year (–0.51; 95% CI, –0.91 to –0.11) than among those in the usual care arm. This effect was comparatively smaller in the clinical decision plus health coaching study arm (–0.34; 95% CI, –0.75 to 0.07), study results indicated.
However, the researchers found that participants who were most faithful to the clinical decision support plus health coaching intervention achieved the greatest improvements in BMI (–0.53; 95% CI, –1.01 to –0.04), whereas those who were less faithful experienced no improvement compared with usual care (0.02; 95% CI, –0.61 to 0.65).
The researchers also evaluated Healthcare Effectiveness Data and Information Set (HEDIS) performance measures for obesity. They found that, after 1 year, achievement of HEDIS measures was considerably greater in the clinical decision support study arm (adjusted OR=2.28; 95% CI, 1.15-4.53) and the clinical decision support plus health coaching arm (adjusted OR=2.60; 95% CI, 1.25-5.41) than in the usual care arm.
There also appeared to be higher use of HEDIS codes for nutrition or physical activity counseling in the clinical decision support arm and clinical decision support plus health coaching arm vs. usual care (45% and 25%, respectively, vs. 0%; P<.001).
“We found that an intervention that leveraged efficient health information technology to provide [clinical decision support] for pediatric clinicians and that provided an intervention for self-guided behavior change by families resulted in improvements in the children’s BMI,” the researchers wrote.
