Study of Technology to Accelerate Research
Condition: Obesity
MeSH terms: Obesity
Study type: Interventional

Summary: 
      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.
    


Intervention name(s): STAR - Study of Technology to Accelerate Research
Intervention type(s): Behavioral
Intervention description(s): In 14 pediatric practices, 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 comparative effectiveness research evidence on childhood obesity for children 6 to 12 years of age with a BMI ≥ 95th percentile.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment