Promoting Health I: Strengthening Practices & Links to Community Resources
In 2009, ICAAP initiated Promoting Health: Strengthening Practices & Links to Community Resources.
Background & Purpose
A 2007 survey of ICAAP members about obesity care routines identified a need for pediatricians to improve skills at the practice level, particularly in screening and nutritional counseling. It also posed questions about how changes in practice systems and additional practice resources could impact care. In order to address the needs identified by this survey, ICAAP and researchers from the Pediatric Practice Research Group (PPRG) at Children’sMemorialHospitaldeveloped and implemented Promoting Health: Strengthening Practices & Links to Community Resources (Promoting Health).
The major goal of Promoting Health was to engage pediatric practices in Chicago to improve their ability to manage overweight children within the practice, through screening, counseling, and provision of appropriate services, and outside the practice through successful referrals to community programs. The project engaged three diverse Chicago medical practices in a research study. The intervention period was for one year (2010 – 2011) and consisted of physician education, quality improvement activities, and facilitation of referrals to community programs on nutrition and physical activity.
A pre- and post-intervention medical records review was conducted at each practice. Data abstracted from all charts included patient date of birth, gender, date of visit, weight, height, and percentage with Body Mass Index (BMI) calculated at visit. For those children at and over the 95th BMI percentile, the data abstracted included diagnoses, dietary assessment and counseling documentation, physical activity assessment and counseling documentation, labs ordered at visit, and medical and community referrals.
The impact and process outcomes of the project were measured using a number of quantitative and qualitative evaluation tools, some of which were developed specifically for the project. Factors assessed included practice-wide systems, care delivery, referral resource characteristics, patient/family experiences with the referral resources, and clinician feedback related to the project.
Physician education was delivered through three Continuing Medical Education (CME) modules developed for the project: Nutrition for Health, Family and Behavior for Health, and Obesity Metabolic Disorders. Over the course of the project, the modules were presented 32 times, to over 550 attendees. The outcomes of these modules were overwhelmingly positive: 98% of respondents to a post-activity survey either “strongly agreed” or “agreed” that learning objectives were met and over 90% of respondents reported that they had made or intended to make a change to their practice as a result of the educational module(s). Clinicians involved in the project also completed an online clinical counseling module and attended in-person health behavior change training sessions. Clinicians reported incorporating the suggested message and medical knowledge learned from these educational activities into their patient counseling.
Quality Improvement in Intervention Practices
Participating practices were asked to form a multidisciplinary QI team with a physician team leader, a Project Community Coordinator (PCC), and a parent partner. Two of the three QI teams included all full-time physicians who provided pediatric care at their practice. These QI teams met monthly, or bimonthly, to discuss progress towards their QI goals and the results of rapid-cycle medical records reviews. Quality improvement activities were key to bringing about practice system changes, culture shifts, and improvements in obesity care. Medical records reviews following the intervention indicated increases in the rates of documentation of overweight/obesity diagnoses, BMI calculation and plotting, and dietary and physical activity assessment and counseling. Following the intervention, practitioners reported that QI activities accelerated the implementation of recommended clinical management guidelines and led to improved patient health outcomes.
Designated staff (project community coordinators) at each of the intervention practices were supported by Promoting Health at 20% FTE to coordinate referrals to community programs. These community coordinators were responsible for identifying an appropriate hysical activity or nutrition program for patients (with BMI at or above the 85th percentile) referred by physicians, providing patient referrals, and following up with patients to encourage program participation. ICAAP assisted intervention practices with patient referrals by creating a database and map of local community resources and by scheduling presentations from community programs at quality improvement team meetings. All programs listed on the database were researched through a combination of internet research, in-person and phone interviews, and site visits. Currently, there are over 50 organizations (with 300 locations) included on the database. Intervention practices also developed on-site programs for their patients.
Customized family-based nutrition education programs (for delivery in the practice) were created by Promoting Health for two of the intervention practices. One intervention practice also established an on-site physical activity program in partnership with a national organization. The program was sponsored by the practice to overcome multiple patient barriers to program participation outside of the clinic setting. Implementation of this self-esteem building and physical activity program has been so successful that it is considered by Promoting Health to be a replicable model of linking medical practices with community resources to address pediatric obesity.
Promoting Health was funded by the Generous Support of The Otho S.A. Sprague Memorial Institute
For information about Promoting Health II, ICAAP’s current obesity work, click here.
To get involved with Obesity Prevention and Care efforts contact:
Mary Elsner, JD
Director, Obesity Prevention Initiatives
312/733-1026, ext. 220