School-based health centers and obesity prevention: changing practice through quality improvement

To examine whether a quality improvement initiative aimed at medical providers in school-based health centers would improve the recognition and management of pediatric obesity.

Thirteen school-based health centers, with a total of 22 providers and 6 clinical staff, were enrolled in the study. Quality improvement measures and best medical practices for assessing and treating pediatric obesity were provided during 1 learning collaborative and 2 on-site trainings. Measures included documentation of (1) a BMI percentile, (2) a corresponding weight-category diagnosis, (3) assessing readiness to change, (4) assessing readiness to change for patients with a BMI at > or =85th percentile, and (5) addressing 4 key messages that enhance a healthy lifestyle.

Results of paired-sample t tests indicate that all 5 variables significantly increased from baseline to the midpoint data collection. From midpoint to the final data collection, documentation of BMI percentile and key messages increased, although not significantly. Documentation of weight-category diagnosis and readiness to change for patients with a BMI at > or =85th percentile decreased significantly, whereas documentation of readiness to change decreased, but not significantly.

This study offers promising evidence that school-based health center providers trained in a quality improvement initiative demonstrate consistent improvement in implementing the guidelines for treatment of pediatric overweight.