Improving children's obesity-related health care quality: process outcomes of a cluster-randomized controlled trial

Area of Science:

• Pediatric Health
• Clinical Informatics
• Public Health Interventions

Background:

• Childhood obesity is a significant public health concern requiring effective clinical interventions.
• Healthcare quality measures for pediatric obesity management are crucial for improving patient outcomes.
• Existing interventions often lack integrated approaches for clinicians and parents.

Purpose of the Study:

• To evaluate an intervention combining electronic decision support for pediatricians with direct-to-parent outreach.
• To assess the impact on healthcare quality measures for managing obese children (aged 6-12 years).
• To compare a dual intervention against point-of-care decision support alone and usual care.

Main Methods:

• A cluster-randomized trial involving 14 pediatric practices and 549 obese children (BMI ≥ 95th percentile).
• Three arms: Intervention-1 (pediatrician decision support), Intervention-2 (decision support + parent outreach), and usual care.
• Key outcomes: Healthcare Effectiveness Data and Information Set (HEDIS) measures for BMI percentile documentation and counseling for nutrition/physical activity.

Main Results:

• Intervention-2 significantly increased the odds of BMI percentile documentation (adjusted OR: 3.97).
• Intervention-2 showed a higher prevalence of counseling for nutrition or physical activity (20.3%) compared to usual care (0.0%).
• Intervention-1 did not yield significant improvements in these HEDIS measures compared to usual care.

Conclusions:

• A combined intervention of clinician decision support and parent outreach effectively improved healthcare quality for pediatric obesity.
• Direct-to-parent communication alongside clinical decision support is key to enhancing obesity care quality.
• This integrated approach offers a promising strategy for managing childhood obesity in primary care settings.