Improving Primary Care Management of Pediatric Obesity
Improving Primary Care Management of Pediatric Obesity
Introduction: Despite the existence of established guidelines addressing pediatric obesity, many primary care providers fail to successfully implement recommendations. This study measured the impact of Six to Success, a weight management program based on the Chronic Care Model, on primary care provider adherence to pediatric weight management guidelines.
Method: We used comprehensive pre- and postimplementation chart audits (N = 396) to conduct a quality improvement study at a hospital-based pediatric outpatient clinic. Charts of patients with a body mass index percentile at or above the 85th percentile (preimplementation, n = 90; postimplementation, n = 97) were audited for 23 identification, assessment, and prevention measures recommended in the care of the pediatric overweight/obese patient.
Results: Statistically significant improvements to clinical guideline adherence were found in the following areas: correct diagnosis, physical examination, lifestyle assessment, use of motivational interviewing, and prevention strategies.
Discussion: These findings suggest that Six to Success can be an effective method of improving primary care provider adherence to established pediatric weight management guidelines.
The childhood obesity epidemic has made it probable that the current generation of children will be the first in recorded history to have a shorter life expectancy than older generations (Ludwig, 2007). Because of the increasing prevalence of childhood overweight/obesity and associated comorbidities, several organizations have called for nurses to take action through improved clinical practice and advocacy for policy reform (American Nurses Association, 2010, Berkowitz and Borchard, 2009, National Association of School Nurses, 2011, National Student Nurses' Association, 2011). Further responding to the urgent need, the American Academy of Pediatrics (AAP) and the National Association of Pediatric Nurse Practitioners (NAPNAP) created recommendations for the assessment, prevention, and treatment of childhood overweight and obesity (Barlow and the Expert Committee, 2007, National Association of Pediatric Nurse Practitioners, 2009). See Box 1 for recommendations.
The AAP and NAPNAP acknowledge that clinicians are faced with addressing the growing problem in traditional medical settings. In pediatric primary care, the traditional visit model works well for acute medical issues; however, complex chronic illnesses such as obesity require a different approach (Barlow & the Expert Committee, 2007). The Chronic Care Model (CCM; see Figure 1) provides a structure that allows for a comprehensive approach to overweight/obesity (Barlow & the Expert Committee, 2007) by taking into consideration clinician decision support, self-management support, computer information systems (CIS), and system delivery design (Wagner, 1998).
(Enlarge Image)
Figure 1.
The Chronic Care Model for childhood obesity. BMI = body mass index; BP = blood pressure; CIS = computer information systems.
© 2010 Jacobson & Gance-Cleveland. Obesity Reviews.
© 2010 International Association for the Study of Obesity.
Despite knowledge about established recommendations for care of the pediatric overweight/obese patient, adherence to standards is lacking in the primary care setting (Cook et al., 2005, Hillman et al., 2009, Kuhle et al., 2011, Mabry et al., 2005). Dissemination of professional guidelines has proven to be inadequate in changing provider practice behaviors (Kryworuchko, Stacey, Bai, & Graham, 2009). These findings suggest that although pediatric providers are aware of the recommendations, they lack the tools necessary for consistent integration into the primary care setting. The purpose of this study is to measure the impact of Six to Success, a weight management program based on the CCM, on primary care provider adherence to pediatric weight management guidelines.
Abstract and Introduction
Abstract
Introduction: Despite the existence of established guidelines addressing pediatric obesity, many primary care providers fail to successfully implement recommendations. This study measured the impact of Six to Success, a weight management program based on the Chronic Care Model, on primary care provider adherence to pediatric weight management guidelines.
Method: We used comprehensive pre- and postimplementation chart audits (N = 396) to conduct a quality improvement study at a hospital-based pediatric outpatient clinic. Charts of patients with a body mass index percentile at or above the 85th percentile (preimplementation, n = 90; postimplementation, n = 97) were audited for 23 identification, assessment, and prevention measures recommended in the care of the pediatric overweight/obese patient.
Results: Statistically significant improvements to clinical guideline adherence were found in the following areas: correct diagnosis, physical examination, lifestyle assessment, use of motivational interviewing, and prevention strategies.
Discussion: These findings suggest that Six to Success can be an effective method of improving primary care provider adherence to established pediatric weight management guidelines.
Introduction
The childhood obesity epidemic has made it probable that the current generation of children will be the first in recorded history to have a shorter life expectancy than older generations (Ludwig, 2007). Because of the increasing prevalence of childhood overweight/obesity and associated comorbidities, several organizations have called for nurses to take action through improved clinical practice and advocacy for policy reform (American Nurses Association, 2010, Berkowitz and Borchard, 2009, National Association of School Nurses, 2011, National Student Nurses' Association, 2011). Further responding to the urgent need, the American Academy of Pediatrics (AAP) and the National Association of Pediatric Nurse Practitioners (NAPNAP) created recommendations for the assessment, prevention, and treatment of childhood overweight and obesity (Barlow and the Expert Committee, 2007, National Association of Pediatric Nurse Practitioners, 2009). See Box 1 for recommendations.
The AAP and NAPNAP acknowledge that clinicians are faced with addressing the growing problem in traditional medical settings. In pediatric primary care, the traditional visit model works well for acute medical issues; however, complex chronic illnesses such as obesity require a different approach (Barlow & the Expert Committee, 2007). The Chronic Care Model (CCM; see Figure 1) provides a structure that allows for a comprehensive approach to overweight/obesity (Barlow & the Expert Committee, 2007) by taking into consideration clinician decision support, self-management support, computer information systems (CIS), and system delivery design (Wagner, 1998).
(Enlarge Image)
Figure 1.
The Chronic Care Model for childhood obesity. BMI = body mass index; BP = blood pressure; CIS = computer information systems.
© 2010 Jacobson & Gance-Cleveland. Obesity Reviews.
© 2010 International Association for the Study of Obesity.
Despite knowledge about established recommendations for care of the pediatric overweight/obese patient, adherence to standards is lacking in the primary care setting (Cook et al., 2005, Hillman et al., 2009, Kuhle et al., 2011, Mabry et al., 2005). Dissemination of professional guidelines has proven to be inadequate in changing provider practice behaviors (Kryworuchko, Stacey, Bai, & Graham, 2009). These findings suggest that although pediatric providers are aware of the recommendations, they lack the tools necessary for consistent integration into the primary care setting. The purpose of this study is to measure the impact of Six to Success, a weight management program based on the CCM, on primary care provider adherence to pediatric weight management guidelines.
