title: Improving providers' assessment and management of childhood overweight: results of an intervention.
abstract: OBJECTIVE
  Pediatric primary care providers' adherence to recommendations for the assessment and management of childhood overweight is low. There are scarce data addressing how to improve provider practices. This study evaluated the effect of provider training and office-based tool dissemination on pediatric providers' assessment and management of childhood overweight.
  
  
  METHODS
  Provider practices before and after training and office-based tool dissemination were compared. Participants were resident and faculty providers at 6 urban, community-based primary care clinics affiliated with an academic medical center. Three months after completion of two 1-hour training sessions, clinic sites were provided with tools in bulk, and office staff were coached to distribute the tools during patient encounters. Provider practices were ascertained by medical record abstraction at baseline and at 3 and 6 months. The proportion of medical records with documentation of recommended practices, including recording of body mass index percentile (BMI%), obtaining a nutrition-activity history, and providing nutrition-activity counseling, was compared with chi(2) tests and logistic regression.
  
  
  RESULTS
  During the initial 3 months after training, provider documentation of recommended practices did not significantly improve compared with baseline. During the subsequent 3 months, after office-based distribution of tools, provider documentation of recommended practices improved significantly compared with baseline (28.8% vs 11.6% for BMI% [P < .001], 80.2% vs 49.8% for nutrition-activity history [P < .001], and 47.7% vs 33.3% for nutrition-activity counseling [P < .001]).
  
  
  CONCLUSIONS
  Pediatric providers' adherence to recommendations for the assessment and management of childhood overweight may improve with provider training linked to the office-based distribution of tools to promote performance of recommendations.
authors.affiliation: Emory University School of Medicine, Department of Family & Preventive Medicine, Atlanta, GA 30322, USA. amlang@emory.edu
authors.forename: Anne L
authors.initials: AL
authors.lastname: Dunlop
authors.forename: Zanie
authors.initials: Z
authors.lastname: Leroy
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Trowbridge
authors.forename: Debra L
authors.initials: DL
authors.lastname: Kibbe
mesh_terms: D015992:Body Mass Index; D002648:Child; D003376:Counseling; D004032:Diet; D005260:Female; D006293:Health Promotion; D006801:Humans; D008297:Male; D008499:Medical Records; D050177:Overweight / Q000175:diagnosis / Q000628:therapy*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care