In the Journals

Computerized decision support tools improve BMI in children

An obesity intervention program that includes computerized clinical decision support for physicians as well as health coaching for families significantly improved BMI rates in obese children, according to new study findings.

According to background information provided in the study, the prevalence of childhood obesity in the U.S. remains historically high and cost-effective, scalable clinical approaches for improving obesity rates in children are a public health priority. Yet, BMI interventions in children have not been proven effective in primary care.

Elsie Taveras

Elsie M. Taveras

Researchers led by Elsie M. Taveras, MD, MPH, of Massachusetts General Hospital for Children, sought to assess the extent to which computerized clinical decision support delivered to pediatric clinicians at the point of care of obese children, with or without individualized family coaching, improved BMI and quality of care.

For the three-arm clinical trial, researchers enrolled 549 children aged between 6 and 12 with BMI levels at the 95% percentile or higher treated across 14 primary care practices between October 2011 and June 2012. Patients were followed for up to 1 year.

Five of the 14 practices including 194 children received clinical decision support tools where the existing electronic health record was modified to alert pediatricians to a child with a high BMI. Links were provided to growth charts, obesity screening guidelines and referrals for weight management programs.

In addition, pediatricians provided educational materials for families and follow-up visits focused on behavioral changes — decreasing “screen time”, less consumption of sugar-sweetened beverages, increased exercise and sleep.

Five other practices, including 171 children received clinical decision support tools plus a health coach that worked with families via telephone, text message and email. The final 184 children treated at the remaining four practices were assigned to usual care, including no clinical decision support tool for obesity.

Children with the greatest improvements in BMI were those with families and pediatricians that participated in, and were most faithful to, the intervention that included clinical decision support tools in pediatric practices and health coaching for the family, according to study results.

When compared with children who received usual care, children who were the most faithful to clinical decision support in addition to the coaching intervention experienced the greatest improvements in BMI — a reduction of 0.53. Whereas participants who did not adhere as closely to the intervention did not achieve improvements in BMI.

Moreover, overall BMI rates increased less in children assigned the clinical decision support intervention with a reduction of 0.51. Children assigned the clinical decision support plus health coaching intervention achieved a smaller magnitude of improvement in BMI, with a reduction of 0.34 vs. usual care.

The researchers noted that no differences were observed in weight management among the three study arms at 1 year.

“We found that an intervention that leveraged efficient health information technology to provide clinical decision support for pediatric clinicians and that provided an intervention for self-guided behavior change by families resulted in improvements in the children’s BMI,” the researchers wrote.

Disclosures: The researchers report no relevant financial disclosures.

An obesity intervention program that includes computerized clinical decision support for physicians as well as health coaching for families significantly improved BMI rates in obese children, according to new study findings.

According to background information provided in the study, the prevalence of childhood obesity in the U.S. remains historically high and cost-effective, scalable clinical approaches for improving obesity rates in children are a public health priority. Yet, BMI interventions in children have not been proven effective in primary care.

Elsie Taveras

Elsie M. Taveras

Researchers led by Elsie M. Taveras, MD, MPH, of Massachusetts General Hospital for Children, sought to assess the extent to which computerized clinical decision support delivered to pediatric clinicians at the point of care of obese children, with or without individualized family coaching, improved BMI and quality of care.

For the three-arm clinical trial, researchers enrolled 549 children aged between 6 and 12 with BMI levels at the 95% percentile or higher treated across 14 primary care practices between October 2011 and June 2012. Patients were followed for up to 1 year.

Five of the 14 practices including 194 children received clinical decision support tools where the existing electronic health record was modified to alert pediatricians to a child with a high BMI. Links were provided to growth charts, obesity screening guidelines and referrals for weight management programs.

In addition, pediatricians provided educational materials for families and follow-up visits focused on behavioral changes — decreasing “screen time”, less consumption of sugar-sweetened beverages, increased exercise and sleep.

Five other practices, including 171 children received clinical decision support tools plus a health coach that worked with families via telephone, text message and email. The final 184 children treated at the remaining four practices were assigned to usual care, including no clinical decision support tool for obesity.

Children with the greatest improvements in BMI were those with families and pediatricians that participated in, and were most faithful to, the intervention that included clinical decision support tools in pediatric practices and health coaching for the family, according to study results.

When compared with children who received usual care, children who were the most faithful to clinical decision support in addition to the coaching intervention experienced the greatest improvements in BMI — a reduction of 0.53. Whereas participants who did not adhere as closely to the intervention did not achieve improvements in BMI.

Moreover, overall BMI rates increased less in children assigned the clinical decision support intervention with a reduction of 0.51. Children assigned the clinical decision support plus health coaching intervention achieved a smaller magnitude of improvement in BMI, with a reduction of 0.34 vs. usual care.

The researchers noted that no differences were observed in weight management among the three study arms at 1 year.

“We found that an intervention that leveraged efficient health information technology to provide clinical decision support for pediatric clinicians and that provided an intervention for self-guided behavior change by families resulted in improvements in the children’s BMI,” the researchers wrote.

Disclosures: The researchers report no relevant financial disclosures.