Implementation of 12345 Fit-Tastic! in Pediatric Primary Care
Background: Pediatric primary care providers (PCPs) are ideally positioned to deliver obesity prevention and stage 1 (Prevention Plus) obesity treatment. Lack of time and educational resources have been cited as major barriers to implementation.
Purpose: To describe the implementation and preliminary outcomes of an obesity prevention/stage 1 obesity treatment pilot intervention in an academic general pediatrics clinic.
Methods: Focus group and electronic survey input informed development of the clinic staff training package and staged implementation of the intervention. Training was delivered to attending providers and nursing staff, including provider education on expert committee recommendations for obesity prevention and staged treatment, a community-informed healthy lifestyles message (12345 Fit-Tastic!), and an electronic medical record-embedded healthy weight assessment (HWA) and plan (HWP) for children aged 2-19 presenting for well child visits. The HWA evaluated the 5 behaviors related to the healthy lifestyles message in addition to weight status, and the HWP options included 5 related recommendations. Clinic staff documentation of the HWA and HWP and type of HWP given were the initial outcomes, and were tracked for 16 months following implementation. Monthly progress reports were given to clinic staff and improvement ideas were solicited.
Results: 14,188 patients were seen in the study period. Nursing staff performance and documentation of HWAs quickly rose and was maintained at 89%. Provider documentation of HWPs (via provider delivery or order requesting nursing staff to deliver) was slower to improve, but by 12 months ranged between 50-73% after clinic staff suggestions and process improvements were implemented. In total, 12,635 HWAs and 5,040 HWPs were delivered. HWPs were most often given to preschoolers (44.9%), followed by school-aged children (43.4%), and least often given to teens (11.7%). More overweight and obese patients who were assessed received HWPs (61.5%), compared with healthy weight patients (40.6%). Counseling was most often given regarding fruit/vegetable intake (28.7%), followed by water intake (instead of sugary drinks) (17.4%), physical activity (15.2%), screen time (14.8%), low fat/nonfat milk/yogurt intake (14.1%) and other (9.9%).
Conclusions: Preliminary analysis demonstrates that a primary care-based obesity prevention/treatment intervention is feasible to implement, and that staff-initiated process improvements with electronic medical record utilization can enhance assessment and counseling rates.
Figure 1. Percent of patients receiving HWA and HWP by month (2012-2013)
Figure 2. HWP topics