Improving Pediatric Obesity Practice Using Prompts

Overview

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.

Full Title of Study: “Improving Pediatric Obesity Practice Using Prompts (iPOP-UP): Using Electronic Health Records to Support Decision-Making in Pediatric Obesity Care”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: N/A
    • Intervention Model: Single Group Assignment
    • Primary Purpose: Health Services Research
    • Masking: None (Open Label)
  • Study Primary Completion Date: September 2020

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.

Interventions

  • Behavioral: Interruptive Clinical Decision Support
    • An interruptive, “soft-stop” alert will pop up when a pediatric primary care provider open a child’s electronic health record (i.e., a new window in the forefront of the screen interrupting workflow and requiring the clinician to take an action) alerting them that the child meets criteria for obesity based on their age/sex-specific BMI percentile. The pop-up alert includes: One-click addition of elevated BMI to problem list Reminder to utilize Suggested PowerPlan One-click access to a patient handout on evidence-based behavior change goals (screen time, sugary drinks, physical activity, sleep) and link to additional handouts and resources Tables displaying trends in growth measures, blood pressure and relevant laboratory tests Links to existing, evidence-based childhood obesity screening and management guidelines

Arms, Groups and Cohorts

  • Experimental: Interruptive Clinical Decision Support

Clinical Trial Outcome Measures

Primary Measures

  • Change in body mass index (BMI)
    • Time Frame: 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)
    • Time Frame: 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
    • Time Frame: 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
    • Time Frame: 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
    • Time Frame: 1-year pre-implementation compared to 1-year post-implementation
  • Change in proportion of patients with obesity with follow-up or referral orders
    • Time Frame: 1-year pre-implementation compared to 1-year post-implementation

Secondary Measures

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

Participating in This Clinical Trial

All pediatric primary care providers providing well child care for patients ages 2-17 years-old in the Boston Children's Hospital primary care practices will be eligible for the study. There are no exclusion criteria.

Gender Eligibility: All

Minimum Age: N/A

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Yale University
  • Collaborator
    • Boston Children’s Hospital
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Official(s)
    • Corinna Rea, MD, MPH, Principal Investigator, Boston Children’s Hospital

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