title: Modifying Provider Practice To Improve Assessment of Unhealthy Weight and Lifestyle in Young Children: Translating Evidence in a Quality Improvement Initiative for At-Risk Children.
abstract: BACKGROUND
  We designed a quality improvement (QI) project to address the high prevalence of childhood overweight and obesity (OW/OB) in our patient population and the inconsistencies among primary care providers in recognizing and addressing OW/OB.
  
  
  METHODS
  We used mixed methods data collection approach to evaluate a QI project, the Childhood Healthy Behaviors Intervention (CHBI), to improve provider obesity prevention practice in two low-income, predominantly African American pediatric primary care clinics. Electronic record data were extracted from all 2-9 year well visits pre- and postintervention for frequency of appropriate diagnostic coding of OW/OB. We reviewed a random sample of records for details of health habit assessment and counseling documentation. Focused interviews were conducted to elicit provider responses regarding impressions of the intervention.
  
  
  RESULTS
  The preintervention sample of records (n = 267) was extracted from 18 providers and the postsample (n = 253) from 19 providers. Providers showed improvement in the recognition of OW/OB with appropriate diagnostic coding (52% pre, 68% post), improvement in assessment of health habits informed by the habit survey (0% pre, 76% post), improvement in counseling of healthy behaviors (86% pre, 92% post), and improvement in goal setting of healthy behaviors (12% pre, 70% post).
  
  
  CONCLUSIONS
  Our findings suggest that implementing a time efficient primary care intervention with brief provider training can improve provider recognition of OW/OB, as well as improve provider behavior targeted at childhood obesity prevention. This project contributes needed QI evidence on interventions to prevent and address OW/OB in primary care settings and calls for further work to strengthen implementation in similar contexts.
authors.affiliation: 1 Goldberg Center for Community Pediatric Health , Children's National Health System, Washington, DC.|2 School of Nursing, The Catholic University of America , Washington, DC.|3 School of Medicine and Health Sciences, The George Washington University , Washington, DC.
authors.forename: Nadine L
authors.initials: NL
authors.lastname: Camp
authors.affiliation: 2 School of Nursing, The Catholic University of America , Washington, DC.
authors.forename: Rebecca C
authors.initials: RC
authors.lastname: Robert
authors.affiliation: 1 Goldberg Center for Community Pediatric Health , Children's National Health System, Washington, DC.|3 School of Medicine and Health Sciences, The George Washington University , Washington, DC.
authors.forename: Jessica E
authors.initials: JE
authors.lastname: Nash
authors.affiliation: 1 Goldberg Center for Community Pediatric Health , Children's National Health System, Washington, DC.|3 School of Medicine and Health Sciences, The George Washington University , Washington, DC.
authors.forename: Cara B
authors.initials: CB
authors.lastname: Lichtenstein
authors.affiliation: 1 Goldberg Center for Community Pediatric Health , Children's National Health System, Washington, DC.|3 School of Medicine and Health Sciences, The George Washington University , Washington, DC.
authors.forename: Candice S
authors.initials: CS
authors.lastname: Dawes
authors.affiliation: 4 Department of Nursing Research and Quality Outcomes, Children's National Health System , Washington, DC.
authors.forename: Katherine Patterson
authors.initials: KP
authors.lastname: Kelly
mesh_terms: D015992:Body Mass Index; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D005260:Female; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D008297:Male; D063766:Pediatric Obesity / Q000175:diagnosis* / Q000517:prevention & control / Q000628:therapy; D010372:Pediatrics / Q000193:education; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000379:methods; D058996:Quality Improvement; D011787:Quality of Health Care; D012307:Risk Factors
keywords: child habit assessment; overweight/obesity; primary care intervention; quality improvement; recognition of abnormal BMI