Study of Technology to Accelerate Research

Childhood obesity is highly prevalent and is associated with both short- and long-term
adverse outcomes.

Despite availability of guidelines for nearly a decade and more recent comparative
effectiveness research (CER) evidence, the health care system has been slow to adopt
recommended practices. Although pediatric health care providers often cite barriers such as
limited time, skill, and resources, a frequently overlooked barrier is the lack of data
systems to efficiently and accurately assess guideline implementation and to improve quality
of care for childhood obesity. Health information technology (HIT) offers potential for
accelerating the adoption of CER evidence regarding childhood obesity screening and
management, for establishing treatment benchmarks, and for supporting patients and their
clinical teams in care improvement. Incorporation of HIT may be especially effective if
augmented by outreach to parents and children.

The goal of this study is to develop and test system-level interventions to accelerate the
adoption of CER evidence on childhood obesity screening and management, and ultimately
improve obesity-related health care quality and outcomes. To achieve this goal, the
investigators will work with two health care systems in Massachusetts with strong track
records of research collaboration: Cambridge Health Alliance (CHA), an integrated academic
public health system, and Harvard Vanguard Medical Associates (HVMA), a large multi-site
group practice. Both systems use an electronic medical record for all aspects of ambulatory
care, including point of care services such as electronic order entry and centralized
functions such as patient scheduling.

In these settings of innovation and commitment to improving quality of care, the
investigators will develop and test two systematic strategies for adoption of CER evidence.
The first incorporates computerized point of care decision alerts to pediatric primary care
providers during routine office visits, linked to CER-based algorithms of care. The second
augments this HIT approach with direct-to-parent communication of child's body mass index
(BMI) along with recommended evaluation and management. The specific aims of this study are:

1. In 18 community health centers of CHA, to identify barriers to and facilitators of
adoption of an existing set of computerized point of care decision alerts for childhood
obesity screening and management. The investigators will achieve this aim through
in-depth interviews and surveys with primary care clinicians, which will inform the
design of the investigators proposed intervention.

2. In 14 practices of HVMA, to conduct a cluster-randomized controlled trial to examine
the extent to which computerized point of care decision alerts to pediatric primary
care providers, with or without direct-to-parent communications, will increase adoption
of CER evidence on childhood obesity for children 6 to 12 years of age with a BMI ≥
95th percentile. The investigators will determine the extent to which each of the 2
intervention conditions, compared with the usual care control condition and with each
other, results in:

1. Increased screening and assessment of childhood obesity at the point of care,
including BMI, blood pressure, and laboratory screening, and provision of
nutrition and physical activity counseling,

2. A smaller age-associated increase in BMI over a 1-year period, and,

3. Improved specific dietary, physical activity, and sedentary behaviors over a
1-year period.

3. To evaluate each intervention's costs (including clinician and family time) and
cost-effectiveness in terms of children's change in BMI and weight-related behaviors.

4. To develop a detailed dissemination guide to further accelerate adoption of CER
evidence on childhood obesity in practices and communities interested in implementing
similar interventions.

To achieve the investigators aims, the investigators have assembled a research team with
extensive experience in obesity prevention, clinician and child behavior change, clinical
informatics, statistical methodology in cluster randomized controlled trials,
cost-effectiveness analyses, and dissemination science. If successful, this project will
provide new and sustainable approaches for accelerating adoption of CER evidence for
childhood obesity screening and management and for improving quality of care for childhood
obesity in pediatric primary care.