population effects of mi on pediatric obesity in primary care

Conditions: Pediatric Obesity

Summary: in this cluster randomized effectiveness trial, pediatric primary care practices will be recruited from the american academy of pediatrics' national pediatric research in office settings (pros) practice-based research network, as well as the client database of the physician's computer company (pcc) - an electronic health record (ehr) vendor. we will recruit 18 practices. 9 practices will be randomized to the intervention arm and 9 practices to usual care. intervention arm practices will select 1-2 pediatric clinicians, including pediatricians (ped) and nurse practitioners (np), to receive in-person training in motivational interviewing (mi), behavioral therapy, billing and coding, and study procedures. usual care practices will select 1-2 pediatric clinicians to receive billing / coding and study protocol training only, via telephone and webinar; they will be offered in-person mi training at the close of the trial. around 316 parents of overweight or obese children (bmi \> 85th percentile for age and gender) between 3 and 11 years of age at baseline that are patients of participating intervention arm clinicians will be enrolled. over 24 months, these parents may receive up to 4 in-person, mi-based counseling sessions with a trained pediatric clinician and up to 6 telephone counseling sessions with an mi-trained registered dietician (rd). there will be no study-specific contact with parents or their children in usual care practices during the trial - they will continue to receive usual care. ehr and billing data for all 3-11 year old children within all participating practices will be extracted by pcc to permit determination of the effectiveness of the intervention versus usual care on change in bmi z-score among 3 groups: 1) all eligible children in the intervention arm), 2) all eligible children whose parent actively participates in the trial , and 3) all 3-11 year old children in all participating practices.


Eligibility criteria:
inclusion criteria: * for practices: currently use physician's computer company (pcc) as their electronic health record (ehr) vendor * for clinicians: have been employed by the practice for at least 1 year on or before july 1, 2017 work \> half time (at least 6 sessions per week) * for parents: parent or legal guardian of a child that meets the following criteria: at least 3 but not yet 12 years of age on the date of the baseline data pull (estimated to occur in the summer or fall of 2017). bmi for age and gender \> 85th percentile - documented at an office visit that occurred during the 12 months prior to the baseline data pull. most recent well-child visit was with a participating study clinician during the 24 months prior to the baseline data pull exclusion criteria: * for practices: offer a comprehensive weight loss program or access to a rd at or through the practice. unable or unwilling to send all participating study clinicians to in-person training.unable or unwilling to identify and assign a study coordinator for the study * for clinicians: \> 1 day of prior training in mi within the past 10 years. prior participation in the aap/pros healthy lifestyles pilot study (hls; aap irb protocol # 01sc01) or brief motivational interviewing to reduce body mass index (bmi2) study (aap irb protocol # 07re01). * for parents: does not speak either english or spanish. parent or legal guardian of a child who has any of the following documented in their ehr: type i or type ii diabetes. daily or chronic use of medications known to affect growth and mood / behavior (growth hormones, ssris, stimulants).use of atypical antipsychotics. a chronic, limiting, severe medical disorder, syndrome, or other condition (e.g., downs syndrome, cerebral palsy)