Implementation of the
            <i>Connect for Health</i>
            pediatric weight management program: study protocol and baseline characteristics

Simione, Meg; Farrar-Muir, Haley; Mini, Fernanda Neri; Perkins, Meghan; Luo, Man; Frost, Holly M.; Orav, E. John; Metlay, Joshua P.; Zai, Adrian H.; Kistin, Caroline J.; Sease, Kerry; Hambidge, Simon J.; Taveras, Elsie M.

doi:10.2217/cer-2021-0076

Cited by 5 publications

(10 citation statements)

References 35 publications

(29 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The program is intended for delivery during a well-child visit to children ages 2 to 12 years with a body mass index≥85th percentile. Based on the positive results from the effectiveness trial, the program was then adapted, implemented, and evaluated in 3 health care organizations, with the goal of informing future adoption and expansion efforts by evaluating the effectiveness of implementation strategies to facilitate the uptake of the program 10 …”

mentioning

confidence: 99%

“…Based on the positive results from the effectiveness trial, the program was then adapted, implemented, and evaluated in 3 health care organizations, with the goal of informing future adoption and expansion efforts by evaluating the effectiveness of implementation strategies to facilitate the uptake of the program. 10 In addition to effectiveness, complex implementation adoption and expansion decisions are also influenced by the costs of implementation and sustainment. [11][12][13][14][15] Best practices and guidance for assessing EBP implementation costs are emerging; 12,13,[16][17][18][19][20][21][22][23] key best practices include considering implementation costs (eg, related to implementation strategies) and EBP costs (eg, time of providers to deliver EBP), disaggregating costs across time and categories when possible, being attentive to context, and conducting sensitivity analyses.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Costs to Implement a Pediatric Weight Management Program Across 3 Distinct Contexts

Smith,

Simione,

Farrar-Muir

et al. 2023

Medical Care

Self Cite

View full text Add to dashboard Cite

Background: The Connect for Health program is an evidence-based program that aligns with national recommendations for pediatric weight management and includes clinical decision support, educational handouts, and community resources. As implementation costs are a major driver of program adoption and maintenance decisions, we assessed the costs to implement the Connect for Health program across 3 health systems that primarily serve low-income communities with a high prevalence of childhood obesity. Methods: We used time-driven activity-based costing methods. Each health system (site) developed a process map and a detailed report of all implementation actions taken, aligned with major implementation requirements (eg, electronic health record integration) or strategies (eg, providing clinician training). For each action, sites identified the personnel involved and estimated the time they spent, allowing us to estimate the total costs of implementation and breakdown costs by major implementation activities. Results: Process maps indicated that the program integrated easily into well-child visits. Overall implementation costs ranged from $77,103 (Prisma Health) to $84,954 (Denver Health) to $142,721 (Massachusetts General Hospital). Across implementation activities, setting up the technological aspects of the program was a major driver of costs. Other cost drivers included training, engaging stakeholders, and audit and feedback activities, though there was variability across systems based on organizational context and implementation choices. Conclusions: Our work highlights the major cost drivers of implementing the Connect for Health program. Accounting for context-specific considerations when assessing the costs of implementation is crucial, especially to facilitate accurate projections of implementation costs in future settings.

show abstract

mentioning

confidence: 99%

mentioning

confidence: 99%

Costs to Implement a Pediatric Weight Management Program Across 3 Distinct Contexts

Smith,

Simione,

Farrar-Muir

et al. 2023

Medical Care

Self Cite

View full text Add to dashboard Cite

show abstract

“…Other studies with initiation at ages 9–10 do show increased completion with longer follow-up times. 21 , 22 There was a notable decrease in the percentage of HPV vaccination (percent of missed opportunities) during in-person visits from September to December 2021, but overall post-implementation there was an increase in total numbers of HPV vaccine given. For context, the omicron variant surge started in December 2021 with a surge of both omicron and delta variants occurring in January 2022.…”

Section: Discussionmentioning

confidence: 99%

Does HPV vaccination initiation at age 9, improve HPV initiation and vaccine series completion rates by age 13?

O’Leary

Frost

2023

Human Vaccines & Immunotherapeutics

View full text Add to dashboard Cite

Vaccination for Human Papillomavirus (HPV) is important to reduce rates of cervical and oropharyngeal cancer. We aimed to evaluate if a program to initiate HPV vaccination at 9 years improved initiation and completion rates by 13 years of age. Data on empaneled patients aged 9–13 years from January 1, 2021 to August 30, 2022 were abstracted from the electronic health record. Primary outcome measures included HPV vaccination initiation and series completion by 13 years of age. The secondary outcome measure was missed opportunities for HPV vaccination. In total, 25,888 patients were included (12,433 pre-intervention, and 13,455 post-intervention). The percentage of patients aged 9–13 with an in-person visit who received at least 1 dose of HPV vaccine increased from 30% pre-intervention to 43% post-intervention. The percentage of patients who received 2 doses of vaccine increased from 19.3% pre-intervention to 42.7% post-intervention. For the overall population seen in-person, initiation of HPV vaccination by age 13 years increased from 42% to 54%. HPV completion increased as well (13% to 18%). HPV vaccination initiation at 9 years of age may be an acceptable and effective approach to improving vaccination rates.

show abstract

“…The Connect for Health program and implementation strategies have been described previously . Briefly, the program consists of family materials that support behavioral change and connect families to resources available in English, Spanish, and Haitian Creole.…”

Section: Methodsmentioning

confidence: 99%

“…Progress in reducing obesity prevalence and eliminating disparities can be achieved by implementing effective childhood obesity management interventions in primary care settings . Connect for Health helps to fill that gap by delivering an evidence-based pediatric weight management program for systemwide delivery that leverages community and clinical resources to improve the quality of clinical care for childhood obesity . In a randomized clinical trial (RCT), Connect for Health improved child body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) and family-centered outcomes, including child health-related quality of life and parental empowerment .…”

Section: Introductionmentioning

confidence: 99%

Evaluating the Implementation of the Connect for Health Pediatric Weight Management Program

Simione,

Frost,

Farrar-Muir

et al. 2024

JAMA Netw Open

Self Cite

View full text Add to dashboard Cite

ImportanceAdoption of primary care interventions to reduce childhood obesity is limited. Progress in reducing obesity prevalence and eliminating disparities can be achieved by implementing effective childhood obesity management interventions in primary care settings.ObjectiveTo examine the extent to which implementation strategies supported the uptake of research evidence and implementation of the Connect for Health pediatric weight management program.Design, Setting, and ParticipantsThis quality improvement study took place at 3 geographically and demographically diverse health care organizations with substantially high numbers of children living in low-income communities in Denver, Colorado; Boston, Massachusetts; and Greenville, South Carolina, from November 2019 to April 2022. Participants included pediatric primary care clinicians and staff and families with children aged 2 to 12 years with a body mass index (BMI) in the 85th percentile or higher.ExposuresPediatric weight management program with clinician-facing tools (ie, clinical decision support tools) and family-facing tools (ie, educational handouts, text messaging program, community resource guide) along with implementation strategies (ie, training and feedback, technical assistance, virtual learning community, aligning with hospital performance metrics) to support the uptake.Main Outcomes and MeasuresPrimary outcomes were constructs from the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) Framework examined through parent, clinician, and leadership surveys and electronic health record data to understand the number of children screened and identified, use of the clinical decision support tools, program acceptability, fidelity to the intervention and implementation strategies, and program sustainability.ResultsThe program screened and identified 18 333 children across 3 organizations (Denver Health, 8480 children [46.3%]; mean [SD] age, 7.97 [3.31] years; 3863 [45.5%] female; Massachusetts General Hospital (MGH), 6190 children [33.8%]; mean [SD] age, 7.49 [3.19] years; 2920 [47.2%] female; Prisma Health, 3663 children [20.0%]; mean [SD] age, 7.33 [3.15] years; 1692 [46.2%] female) as having an elevated BMI. The actionable flagging system was used for 8718 children (48%). The reach was equitable, with 7843 children (92.4%) from Denver Health, 4071 children (65.8%) from MGH, and 1720 children (47%) from Prisma Health being from racially and ethnically minoritized groups. The sites had high fidelity to the program and 6 implementation strategies, with 4 strategies (67%) used consistently at Denver Health, 6 (100%) at MGH, and 5 (83%) at Prisma Health. A high program acceptability was found across the 3 health care organizations; for example, the mean (SD) Acceptability of Intervention Measure score was 3.72 (0.84) at Denver Health, 3.82 (0.86) at MGH, and 4.28 (0.68) at Prisma Health. The implementation strategies were associated with 7091 (39%) uses of the clinical decision support tool. The mean (SD) program sustainability scores were 4.46 (1.61) at Denver Health, 5.63 (1.28) at MGH, and 5.54 (0.92) at Prisma Health.Conclusions and RelevanceThese findings suggest that by understanding what strategies enable the adoption of scalable and implementation-ready programs by other health care organizations, it is feasible to improve the screening, identification, and management of children with overweight or obesity and mitigate existing disparities.

show abstract

Implementation of the Connect for Health pediatric weight management program: study protocol and baseline characteristics

Cited by 5 publications

References 35 publications

Costs to Implement a Pediatric Weight Management Program Across 3 Distinct Contexts

Costs to Implement a Pediatric Weight Management Program Across 3 Distinct Contexts

Does HPV vaccination initiation at age 9, improve HPV initiation and vaccine series completion rates by age 13?

Evaluating the Implementation of the Connect for Health Pediatric Weight Management Program

Contact Info

Product

Resources

About