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Health Information Technology to Support Clinical Decision Making in Obesity Care
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abstract
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The prevalence of obese adolescents has quadrupled from 1966 to 2006. Along with this increase in obese youth has been an increase in obesity-related chronic illnesses. Significant health disparities exist with minority youth at risk for obesity and its related chronic health conditions. School-based health centers provide primary care for many underserved, minority youth;and provide an avenue for addressing these health disparities. The American Medical Association published recommendations and the National Association of Pediatric Nurse Practitioner's (NAPNAP) developed family-centered, culturally sensitive, clinical practice guidelines (CPGs) for obesity prevention. These publications provide a comprehensive review of the current evidence on maintaining healthy weight in children that incorporates the use of family-centered approaches to care such as motivational interviewing and brief focused negotiation skills to collaborate with families on a plan of care acceptable to them. The provider and family use the resources available in the guidelines and resource kit to create an individualized plan of care that is the best fit for the child in the context of his/her family, school, culture, and environment. However, past research suggests that publication of guidelines rarely changes practice. Computer support for clinical decision making and for tailoring patient education has been developed to facilitate the translation of recommendations into practice. Research, however, is needed to evaluate the role of technology in translating the guidelines into practice and reducing the health disparities in obesity-related conditions. The comparative effectiveness randomized clinical trial is designed to evaluate the implementation of the current obesity prevention guidelines into practice in school-based health centers. The study will compare two methods of training providers on the current recommendations: web-based training on the guidelines, and web-based training plus computer support for clinical decision making. The health disparities collaborative and chronic care model will guide the study. The web-based training for providers includes learning sessions and the use of rapid cycle improvement strategies to monitor practice changes. The strategies for practice changes include providing the patient/family with self-management support, using relationship focused methods such as brief focused negotiation based upon motivational interviewing, computer support for clinical decisions based upon evidence-based practice, delivery-system redesign to promote better care and follow up, and clinical information systems to provide data to evaluate the progress in meeting goals. Data collection strategies include: (1) chart reviews for documentation of adherence to guidelines, (2) parent surveys of provider support, (3) providers'self report of system changes and their knowledge, attitudes and behaviors, (4) evaluation of components of chronic care model, and (5) focus groups regarding the barriers and facilitators to adoption of guidelines and technology.
PUBLIC HEALTH RELEVANCE: The number of overweight children along with the obesity-related illnesses such as diabetes, high blood pressure, musculoskeletal and respiratory conditions continues to increase, and minority youth are most at risk. Primary care providers report difficulties in addressing weight management in youth, so the American Medical Association and the National Association of Pediatric Nurse Practitioners developed guidelines for providers in addressing these issues with patients;however, past research suggests that providers do not use guidelines. Computer technology may improve the use of the latest recommendations in practice;therefore the purpose of this study is to examine the best way to train providers on the use of guidelines and evaluate the use of computer technology in improving care for those most affected by these problems.
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