Improving Pediatric Obesity Practice Using Prompts

Study Overview
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Brief Summary
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This study compares the effectiveness of electronic health record (EHR)-based tools to support the management of pediatric obesity in primary care. All clinicians will receive an interruptive pop-up alert We will examine the impact -- the added value versus unintended consequences -- of the interruptive alert on the quality of obesity management in pediatric primary care.

Detailed Description
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The primary specific aims of this study are to: To assess the impact of EHR-based tools for pediatric obesity in primary care. Hypotheses: EHR-based clinical decision support tools that interrupt but support clinical workflow will (1) improve measures of pediatric obesity care quality delivered by clinicians (e.g., addition of obesity to the problem list, recommended screening for comorbidities, and follow-up/referral plans) and (2) result in a reduced rate of BMI increase over one year among children with obesity. To utilize a mixed methods approach with surveys and semi-structured qualitative interviews with clinicians to (1) examine the extent to which the EHR tools positively impact clinicians' awareness, knowledge and adherence to expert guidelines for pediatric obesity management, and (2) to explore the barriers to and facilitators of clinicians' use of the EHR tools and factors that influence adoption.

Official Title
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Improving Pediatric Obesity Practice Using Prompts (iPOP-UP): Using Electronic Health Records to Support Decision-Making in Pediatric Obesity Care

Conditions
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Pediatric Obesity

Intervention / Treatment
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* Behavioral: Interruptive Clinical Decision Support


Participation Criteria
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Eligibility Criteria
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All pediatric primary care providers providing well child care for patients ages 2-17 years-old in the Boston Children's Hospital primary care practices will be eligible for the study. There are no exclusion criteria.
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Interruptive Clinical Decision Support<br> | Behavioral: Interruptive Clinical Decision Support<br>* An interruptive, soft-stop alert will pop up when a pediatric primary care provider open a child's electronic health record (i.e., a new window in the forefront of the screen interrupting workflow and requiring the clinician to take an action) alerting them that the child meets criteria for obesity based on their age/sex-specific BMI percentile. The pop-up alert includes: One-click addition of elevated BMI to problem list Reminder to utilize Suggested PowerPlan One-click access to a patient handout on evidence-based behavior change goals (screen time, sugary drinks, physical activity, sleep) and link to additional handouts and resources Tables displaying trends in growth measures, blood pressure and relevant laboratory tests Links to existing, evidence-based childhood obesity screening and management guidelines<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in body mass index (BMI) | change in BMI, calculated from height and weight measured as part of routine clinical practice during primary care clinic visits and documented in the EHR | 1 year pre-intervention, baseline, and 1 year post-intervention | 
| Change in percent BMI above the 95th percentile (%BMIp95) | Change in percentage of age/sex-adjusted BMI above the 95th percentile (%BMIp95), calculated from height and weight measured as part of routine clinical practice during primary care clinic visits and documented in the EHR | 1 year pre-intervention, baseline, and 1 year post-intervention | 
| Change in documentation of elevated BMI diagnosis | Change in proportion of patients with obesity who have elevated BMI documented in the EHR | 1-year pre-implementation compared to 1-year post-implementation | 
| Change in proportion of patients with obesity | Change in proportion of patients with obesity who receive age-appropriate screening for comorbidities (blood measure measurement and age-appropriate laboratory screening) | 1-year pre-implementation compared to 1-year post-implementation | 
| Change in proportion of patients with obesity who have counseling for obesity-related behavior change documented in the EHR |  | 1-year pre-implementation compared to 1-year post-implementation | 
| Change in proportion of patients with obesity with follow-up or referral orders |  | 1-year pre-implementation compared to 1-year post-implementation | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in provider knowledge, attitudes and practice around obesity management in primary care assessed via an electronic surveys and qualitative interviews of clinicians |  | baseline compared to 6 months post-implementation | 
| System usability scale (SUS) score | the system usability scale is a validated 10-item measure of system usability | 6 months post-implementation | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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clinical decision support, pediatric obesity, electronic health record