4L-4 IMPLEMENTATION OF ELECTRONIC CLINICAL DECISION SUPPORT FOR OBESITY MANAGEMENT IN PEDIATRIC PRIMARY CARE AND CHANGE IN PARENT-REPORTED HEALTHCARE SATISFACTION

Tuesday, October 25, 2016: 4:15 PM
Bayshore Ballroom Salon F, Lobby Level (Westin Bayshore Vancouver)

Mona Sharifi, MD, MPH, Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, Meghan Perkins, MPH, Division of General Academic Pediatrics, Massachusetts General Hospital, Boston, MA, Shikha Anand, MD, MPH, National Institute for Children's Health Quality (NICHQ), Boston, MA, Thomas Land, PhD, Massachusetts Department of Public Health, Boston, MA and Elsie Taveras, MD, MPH, Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA
Purpose: Electronic health record (EHR)-based clinical decision support (CDS) tools have been shown to improve the quality of obesity-related care. We describe the implementation of CDS tools in pediatric primary care sites participating in the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) study – a clinical-community intervention to prevent and reduce obesity among low-income children ages 2-12 years old – and examine the extent to which the CDS tools and clinical intervention improved parent-reported healthcare satisfaction.

Methods: MA-CORD was a two-year, multi-sector intervention in two Massachusetts communities. The clinical intervention was implemented at two federally qualified health centers (FQHCs) – MA-CORD 1 and MA-CORD 2 – serving low-income children in the communities. In each FQHC, we conducted a variety of obesity-related quality improvement initiatives including implementation of EHR-based CDS tools to guide obesity management, clinician training, orientation, and coaching in obesity-specific quality improvement, and family resources to support health behavior change. Parents assessed their children’s obesity-related healthcare via eight questions adapted from the validated Patient Assessment of Chronic Illness Care (PACIC). We converted responses to a scale ranging 1 to 5. Given Cronbach’s alpha values (0.83-0.85) suggesting high internal consistency, we combined the eight questions into a mean healthcare satisfaction score. Using multivariable difference in differences linear regression models, we examined 1- and 2-year change in healthcare satisfaction among parents of children seen at the two intervention FQHCs compared to a non-randomized comparison FQHC.

Results: Among 419 children in the study, baseline mean (SD) obesity-related healthcare satisfaction among parents of children at MA-CORD 1 was 2.76 (1.19), MA-CORD 2 was 2.44 (1.15), and the comparison site was 2.50 (1.03). We observed 1-year improvement in parent-reported healthcare satisfaction, adjusted for child, parent and household characteristics, at both MA-CORD intervention FQHCs (MA-CORD 1 = 0.54 [95% confidence interval: 0.19, 0.89] and MA-CORD 2 =0.59 [0.12, 1.06]) relative to the comparison site. At one site, we observed a continued significant difference versus the comparator site at 2-year follow-up (MA-CORD 1 = 0.50 [0.15, 0.85]).

Conclusions: Parent-reported healthcare satisfaction improved following the implementation of a clinical childhood obesity intervention including EHR-based CDS, clinician training and family resources in pediatric primary care. Improved satisfaction may translate to enhanced family engagement in healthcare and yield improved child health outcomes.

See more of: ORAL ABSTRACTS: CHRONIC DISEASE MANAGEMENT

See more of: 38th Annual North American Meeting of the Society for Medical Decision Making