title: Outcomes from an orientation model to reduce attrition in paediatric weight management.
abstract: We aimed to reduce attrition of newly referred patients in a paediatric weight management programme by implementing an orientation to address families' expectations and screen for and support behavioural and mental health problems and psychosocial stressors at programme outset. Orientation impact was monitored with run charts with percentages of scheduled encounters completed. Long-term impact was assessed by comparing patients in the initial 6 months of the orientation to a baseline group of referred patients during the same 6-month time interval in the prior year (Pre-Orientation Group). The outcome measure was programme attrition within 15 months. Groups were compared using Kaplan-Meier survival analysis and Cox proportional hazards regression modelling. Patients in the Orientation Group had a 23% increased odds of attrition compared to patients in the Pre-Orientation group (adjusted Hazard ratio, aHR 1.23; 95% confidence interval, CI: 1.01, 1.51) and shorter median duration of follow-up (2.0 vs. 2.9 months, P = 0.004). An increase in body mass index z-score of 1 unit resulted in a nearly fivefold increased odds of attrition (aHR 5.24; 95% CI: 2.95, 9.3). An orientation for new patients did not reduce attrition within 15 months. We suggest that ongoing retention strategies should be embedded into the treatment phase of the programme.
authors.affiliation: Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA. Ian.Zenlea@trilliumhealthpartners.ca.|Department of Pediatrics, Harvard Medical School, Boston, MA, USA. Ian.Zenlea@trilliumhealthpartners.ca.
authors.forename: I S
authors.initials: IS
authors.lastname: Zenlea
authors.affiliation: Clinical Research Center, Boston Children's Hospital, Boston, MA, USA.
authors.forename: C
authors.initials: C
authors.lastname: Milliren
authors.affiliation: Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA.|New Balance Obesity Prevention Center, Boston Children's Hospital, Boston, MA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Herel
authors.affiliation: New Balance Obesity Prevention Center, Boston Children's Hospital, Boston, MA, USA.|Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA.|Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
authors.forename: E
authors.initials: E
authors.lastname: Thomaseo Burton
authors.affiliation: Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA.
authors.forename: N
authors.initials: N
authors.lastname: Askins
authors.affiliation: Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA.|Department of Pediatrics, Harvard Medical School, Boston, MA, USA.|New Balance Obesity Prevention Center, Boston Children's Hospital, Boston, MA, USA.
authors.forename: D S
authors.initials: DS
authors.lastname: Ludwig
authors.affiliation: Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA.|Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
authors.forename: E T
authors.initials: ET
authors.lastname: Rhodes
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D015992:Body Mass Index; D001900:Boston; D002648:Child; D002652:Child Behavior; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004038:Diet, Reducing; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008960:Models, Psychological; D010349:Patient Compliance / Q000523:psychology; D010352:Patient Dropouts; D063766:Pediatric Obesity / Q000178:diet therapy / Q000523:psychology / Q000628:therapy*; D000297:Psychology, Adolescent; D002666:Psychology, Child
keywords: Attrition; paediatric obesity; quality improvement; weight management