A Virtual Childhood Obesity Collaborative
A Virtual Childhood Obesity Collaborative
The framework that guides this study is the Health Disparities Collaborative, which incorporates the CCM (Figure 1). This approach to care is an innovative, data-driven, public health partnership that has improved care for chronic diseases through improved health care delivery systems emphasizing the use of computer information systems and implementation of evidence-based practice (Martin, Larsen, Shea, Hutchins, & Alfaro-Correa, 2007). The CCM is a synthesis of evidence-based system changes to guide quality improvement (QI) and disease management activities (Wagner, 1998).
(Enlarge Image)
Figure 1.
The Chronic Care Model.
BMI% = body mass index percentile; BP% = blood pressure percentile; HSK = HeartSmartKids (decision-support system); MI = motivational interviewing. Adapted with permission from Jacobson and Gance-Cleveland (2011)). This figure appears in color online at www.jpedhc.org.
The goal of the collaborative was rapid QI through the Institute for Healthcare Improvement's Breakthrough Series methodology, the CCM, and learning sessions (Chin et al., 2004). The Breakthrough Series process promotes QI through collaborative learning strategies with quarterly learning sessions, dialogue, process reports, and feedback. Monthly conference calls provide case coaching, progress reports, descriptions of rapid Plan-Do-Study-Act (PDSA) cycles, and reports of adherence to guidelines. At the learning sessions, team members learn QI techniques and share lessons learned.
The CCM is a synthesis of evidence-based system changes that might be used to guide QI and disease management activities (Wagner, 1998). The American Medical Association obesity recommendations suggest the use of the CCM to guide care for overweight/obese children (Barlow, 2007). The model includes practice changes to provide the family with self-management support using relationship-focused methods such as MI; provider decision support for evidence-based care; delivery-system redesign to promote better care and follow-up; and clinical information systems to provide data to evaluate the progress made toward meeting goals. Indirect evidence from the National Health Disparities Collaboratives on Asthma, Diabetes, and Depression suggests that practice-based changes made at the system level will improve patient outcomes (Bodenheimer, 2003, Bodenheimer et al., 2002a, Bodenheimer et al., 2002b, Bray et al., 2005, Hupke et al., 2004, McCullough et al., 2004, Norris and Olson, 2004). The proposed model recognizes that children live in the context of their family, school, and community and that culture and environment have an impact on the child's health. The collaborative approach includes providers advocating for community and environmental changes to promote healthier environments. Cumulative evidence supports the integrated framework for practice improvement, with findings suggesting that use of the collaborative, including the CCM, leads to improved patient care and better health outcomes (Coleman, Austin, Brach, & Wagner, 2009). A systematic review of interventions to improve primary care screening found that successful interventions emphasized the collaborative learning, office-systems changes, and tracking progression over time, but few of the studies focused on follow-up, an area that needs attention (Van Cleave et al., 2012). Application of the break-through series approach to QI and the CCM in the study involved conducting a practice self-assessment, training staff on obtaining and documenting BMI and blood pressure, counseling children and their families using recommendations, evaluating practice for adherence to guidelines using a continuous QI process, and advocating for environmental changes.
The purpose of this descriptive study was to evaluate providers' satisfaction with Web-based continuing education regarding recommendations for the prevention and treatment of childhood obesity. It is part of a larger comparative effectiveness, randomized controlled trial of Web-based training with and without health information technology decision support on providers' implementation of the guidelines in SBHCs serving children 5 to 12 years of age.
Conceptual Framework: Health Disparities Collaborative and CCM
The framework that guides this study is the Health Disparities Collaborative, which incorporates the CCM (Figure 1). This approach to care is an innovative, data-driven, public health partnership that has improved care for chronic diseases through improved health care delivery systems emphasizing the use of computer information systems and implementation of evidence-based practice (Martin, Larsen, Shea, Hutchins, & Alfaro-Correa, 2007). The CCM is a synthesis of evidence-based system changes to guide quality improvement (QI) and disease management activities (Wagner, 1998).
(Enlarge Image)
Figure 1.
The Chronic Care Model.
BMI% = body mass index percentile; BP% = blood pressure percentile; HSK = HeartSmartKids (decision-support system); MI = motivational interviewing. Adapted with permission from Jacobson and Gance-Cleveland (2011)). This figure appears in color online at www.jpedhc.org.
The goal of the collaborative was rapid QI through the Institute for Healthcare Improvement's Breakthrough Series methodology, the CCM, and learning sessions (Chin et al., 2004). The Breakthrough Series process promotes QI through collaborative learning strategies with quarterly learning sessions, dialogue, process reports, and feedback. Monthly conference calls provide case coaching, progress reports, descriptions of rapid Plan-Do-Study-Act (PDSA) cycles, and reports of adherence to guidelines. At the learning sessions, team members learn QI techniques and share lessons learned.
The CCM is a synthesis of evidence-based system changes that might be used to guide QI and disease management activities (Wagner, 1998). The American Medical Association obesity recommendations suggest the use of the CCM to guide care for overweight/obese children (Barlow, 2007). The model includes practice changes to provide the family with self-management support using relationship-focused methods such as MI; provider decision support for evidence-based care; delivery-system redesign to promote better care and follow-up; and clinical information systems to provide data to evaluate the progress made toward meeting goals. Indirect evidence from the National Health Disparities Collaboratives on Asthma, Diabetes, and Depression suggests that practice-based changes made at the system level will improve patient outcomes (Bodenheimer, 2003, Bodenheimer et al., 2002a, Bodenheimer et al., 2002b, Bray et al., 2005, Hupke et al., 2004, McCullough et al., 2004, Norris and Olson, 2004). The proposed model recognizes that children live in the context of their family, school, and community and that culture and environment have an impact on the child's health. The collaborative approach includes providers advocating for community and environmental changes to promote healthier environments. Cumulative evidence supports the integrated framework for practice improvement, with findings suggesting that use of the collaborative, including the CCM, leads to improved patient care and better health outcomes (Coleman, Austin, Brach, & Wagner, 2009). A systematic review of interventions to improve primary care screening found that successful interventions emphasized the collaborative learning, office-systems changes, and tracking progression over time, but few of the studies focused on follow-up, an area that needs attention (Van Cleave et al., 2012). Application of the break-through series approach to QI and the CCM in the study involved conducting a practice self-assessment, training staff on obtaining and documenting BMI and blood pressure, counseling children and their families using recommendations, evaluating practice for adherence to guidelines using a continuous QI process, and advocating for environmental changes.
The purpose of this descriptive study was to evaluate providers' satisfaction with Web-based continuing education regarding recommendations for the prevention and treatment of childhood obesity. It is part of a larger comparative effectiveness, randomized controlled trial of Web-based training with and without health information technology decision support on providers' implementation of the guidelines in SBHCs serving children 5 to 12 years of age.
Source...