title: Impact of a primary care intervention on physician practice and patient and family behavior: keep ME Healthy---the Maine Youth Overweight Collaborative.
abstract: OBJECTIVE
  To evaluate the effect of a pediatric primary care-based intervention, on improved clinical decision support and family management of risk behaviors for childhood overweight.
  
  
  METHODS
  An experimental field trial was conducted with 12 intervention sites in urban and rural areas of Maine and nonrandomized control sites. Change was assessed by using clinical and parent measures from 9 intervention and 10 control sites before and during the Maine Youth Overweight Collaborative intervention. Longitudinal information was collected from chart audits of patients aged 5-18 years (n = 600), systematic samples of parents collected before (n = 346) and during (n = 386) the intervention in 12 sites, and systematic samples of parents in 9 intervention (n = 235) and 10 control (n = 304) sites collected during the intervention. Surveys of health care providers (n = 14 and 17) before and during the intervention were also collected. Teams worked over 18 months to implement improvements in clinical decision support, including tracking BMI percentiles, identification of overweight patients, appropriate laboratory tests, counseling of families and patients use of a behavioral screening tool, and other improvements following the chronic-care model targeting patients aged 5 to 18 and their families.
  
  
  RESULTS
  Large changes occurred in clinical practice from before to during the Maine Youth Overweight Collaborative: increases in assessment of BMI (38%-94%), BMI percentile for age and gender (25%-89%), use of the 5-2-1-0 behavioral screening tool (0%-82%), and weight classification (19%-75%). Parent surveys indicated improvements in providers' behavior and rates of counseling. Intervention providers reported improvements in knowledge, attitudes, self-efficacy, and practice.
  
  
  CONCLUSIONS
  The Maine Youth Overweight Collaborative intervention improved clinical decision support and family management of risk behaviors, indicating a promising primary care-based approach to address overweight risk among children and youth.
authors.affiliation: Maine Harvard Prevention Research Center, Maine Center for Public Health, 1 Weston Ct, Augusta, ME 04330, USA. mpolacsek@mcph.org
authors.forename: Michele
authors.initials: M
authors.lastname: Polacsek
authors.forename: Joan
authors.initials: J
authors.lastname: Orr
authors.forename: Lisa
authors.initials: L
authors.lastname: Letourneau
authors.forename: Victoria
authors.initials: V
authors.lastname: Rogers
authors.forename: Robert
authors.initials: R
authors.lastname: Holmberg
authors.forename: Karen
authors.initials: K
authors.lastname: O'Rourke
authors.forename: Cindy
authors.initials: C
authors.lastname: Hannon
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Lombard
authors.forename: Steven L
authors.initials: SL
authors.lastname: Gortmaker
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001294:Attitude to Health; D001521:Behavior Therapy; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D005195:Family Relations; D005260:Female; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D008019:Life Style; D008281:Maine; D008297:Male; D050177:Overweight / Q000517:prevention & control*; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000379:methods*; D011336:Probability; D012309:Risk-Taking; D012680:Sensitivity and Specificity; D012737:Sex Factors