Health Information Technology to Support Clinical Decision Making in Obesity Care

The prevalence of overweight youth nearly quadrupled in the past four decades. An alarming increase in the number of poor, underserved, overweight minority youth is reported. This dramatic increase in overweight youth has led to the emergence of associated co-morbidities such as dyslipidemia, hypertension, type 2 diabetes, musculoskeletal disorders, respiratory conditions, and emotional problems in youth as well as increased risks of cardiovascular disease and cancer as adults. School-based health centers (SBHCs) provide access to primary care for many underserved and minority youth at risk for obesity and related chronic conditions. Primary care providers (PCPs), however, including those at SBHCs, face a number of barriers to addressing weight management in children. The rising prevalence of obesity and difficulty in identifying, assessing, and maintaining healthy weight in children and adolescents led national groups to convene expert panels that have published evidence-based guidelines. These guidelines include screening for cardiovascular risk factors and using a family-centered and culturally sensitive approach to care. The recommendations incorporate the use of motivational interviewing (MI) and the chronic care model to collaborate with families on a plan of care to improve children's health outcomes. The publication of recommendations or guidelines, however, traditionally has not changed provider behavior. Studies have shown widespread failure to follow established guidelines for a variety of conditions. The barriers to implementing guidelines include inadequate tools or resources, insufficient knowledge and skills, lack of self-efficacy, lack of time, and insufficient reimbursement. Health information technology (HIT) serves as a mechanism for providing decision support and tailored patient education materials to improve evidence-based care for the prevention of obesity and related conditions. Self-efficacy regarding obesity counseling has been linked to access to HIT. Other studies indicate that patients who received written health information with graphics that depicted their response to therapy improved their motivation to adhere to the treatment plan and were more satisfied with care. The proposed study is a comparative-effectiveness trial evaluating the impact of web-based provider training with and without HIT for provider decision support and tailored patient education. The goal is to translate into practice the current evidence-based guidelines for the prevention of obesity-related chronic conditions. HeartSmartKids™ is a decision-making tool that integrates patient health information with evidence-based guidelines and generates graphic trends of cardiovascular risks and tailored recommendations to improve patient outcomes. Elimination of health disparities in the chronic conditions related to childhood obesity depends upon the translation of best evidence into practice by the providers who care to youth at-risk for these obesity-related conditions. The unique features of this study are the SBHC setting; comparative effectiveness of web-based training on current evidence-based recommendations with and without HIT to support providers' decision making and tailored patient education; and the use of the Health Disparities Collaborative, the Institute for Healthcare Improvement's Breakthrough Series quality improvement process, and the chronic care model for childhood obesity for training providers on the current guidelines.