PS2-22: Geisinger Health System's Clinical Interventions for Preventing Pediatric Obesity - Infancy through School-age

Abstract

Background/Aims: Childhood obesity remains a priority issue for the nation and health systems yet little is known about the effectiveness of pediatric obesity prevention interventions overall and evidence is particularly lacking with regard to prevention in clinical settings. Our aim is to discuss process steps in developing two clinical interventions to prevent obesity and their research designs to evaluate effectiveness. Methods: Two interventions were developed, the first to address early childhood obesity prevention among 0-26 month old children and the second to address prevention among children aged 2-9 years, with intentional overlap to coordinate care. A team, comprised of pediatric clinical operations, clinical innovations, research, eHealth, biostatistics, and external university partners, worked collaboratively to develop each intervention and their respective research designs. Results: Each intervention is delivered at scheduled Well Child Visits with consistent components: 1) parent self-reported data to screen for parenting practices, child behaviors, and home environments; 2) parent engagement via screening and risk prioritization; 3) best practice alerts for providers to aid analytical assessment of risk; 4) primary care provider talking points and a SmartSet of parent educational materials; 5) electronic health record progress note construction; and 6) post-visit education. A cluster randomized design is being used to evaluate the effectiveness of both interventions with 6 clinics assigned to the intervention and 6 matched clinics providing standard care. Process outcomes including intervention fidelity and parent engagement are being examined as well as health outcomes. Data are being collected and will be compared to 12-month indicators to evaluate changes in child weight/ length or BMI-for-age and BMI; child behaviors; and parenting practices. Conclusions: A focus on health system goals, a priority health issue, and principles of the learning health care system engaged internal and external entities to leverage resources and successfully develop and implement pediatric obesity prevention interventions. In addition, two pragmatic trials to examine the implementation and effectiveness of the interventions are underway and will contribute to a gap in the evidence base. Participants were 31-to 78-years-old (M = 57), the majority were female (68 %), white (70%), employed, with some college education. Mean HbA1c preintervention was 9.18. Participants showed significant improvement in prepost measures of HbA1c (change .73%, P = .000), overall mental health (Cohen's-d .69, P = .001), stress (Cohen's-d -.76, P = .001), depression (Cohen's-d .62, P = .001), and anxiety (Cohen's-d .66, P = .001). There was also improvement in two measures of diabetes management: Problem Area in Diabetes Questionnaire (Cohen's-d -.71, P = .002) and the Diabetes Empowerment Scale (Cohen's-d .80, P = .000). Conclusions: These results suggest that MBSR may offer a safe and effective method for helping people better manage d...