Dataset Information

Influence of a One-Time Web-Based Provider Intervention on Patient-Reported Outcomes After the Well-Child Visit: A Feasibility Study.

ABSTRACT:

Purpose

Patient-centered care promotes positive health outcomes in pediatrics. We created a provider-focused intervention and implemented it in a pragmatic clustered randomized controlled trial to improve health-related quality of life (HRQOL) among pediatric patients.

Methods

A one-time (1-1.5-hour) webinar focusing on patient-centered care and motivational interviewing, using obesity screening as an example, was developed. Pediatric providers were recruited and randomized to either intervention (webinar) or control (usual care) arms. All well-child visits to these providers for a period of up to 5 months following webinar completion (or study enrollment for controls) were identified, and these family/patients were invited to complete a survey to assess HRQOL postvisit. Reported outcomes were compared between intervention and control participants using clustered t-tests, chi-squared tests and multiple linear regression models.

Results

We recruited 20 providers (10 intervention, 10 control) to the study; 469 parents/guardians and 235 eligible children seeing these providers completed the postvisit survey. Parents/guardians of 8-12-year-old children in the intervention group reported higher school functioning compared to controls (83.5 vs 75.8; P=0.023). There were no other differences in children's HRQOL between intervention and control groups.

Conclusions

A one-time, web-based provider intervention is feasible to implement in pediatrics. Modest evidence, requiring further study, indicates that instructing providers on patient-centered care in the well-child visit may improve aspects of pediatric HRQOL (ie, school functioning) compared to usual care. However, this was a brief intervention, with multiple outcomes tested and no evaluation of pre- and postintervention provider knowledge, thus additional study is needed.

SUBMITTER: Coleman CM

PROVIDER: S-EPMC7834176 | biostudies-literature | 2021

REPOSITORIES: biostudies-literature

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Publications

Influence of a One-Time Web-Based Provider Intervention on Patient-Reported Outcomes After the Well-Child Visit: A Feasibility Study.

Coleman Chad M CM Alexander Gwen L GL Barone Charles C Bossick Andrew S AS Kassem Zeinab Z Lu Mei M Zhou Yueren Y Cassidy-Bushrow Andrea E AE

Journal of patient-centered research and reviews 20210119 1

<h4>Purpose</h4>Patient-centered care promotes positive health outcomes in pediatrics. We created a provider-focused intervention and implemented it in a pragmatic clustered randomized controlled trial to improve health-related quality of life (HRQOL) among pediatric patients.<h4>Methods</h4>A one-time (1-1.5-hour) webinar focusing on patient-centered care and motivational interviewing, using obesity screening as an example, was developed. Pediatric providers were recruited and randomized to eit ...[more]

PMID: 33511253

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Project description:BackgroundFew efficacious pediatric obesity interventions have been successfully translated and sustained in real-world practice, often due to inadequate fit with the priorities of under-resourced populations. Lifestyle interventions, which incorporate tailoring of essential weight loss ingredients and adaptation of mode and intensity to the living circumstances of children with obesity, are needed. The purpose of this pilot study was to test the feasibility and efficacy of a tailored lifestyle intervention for caregivers and their children with obesity, conducted in partnership with Envolve, Inc., a family of comprehensive health solutions and wholly owned subsidiary of Centene Corporation.MethodsThis 6-month pilot study employed a pretest-posttest design to assess the impact of a tailored lifestyle intervention delivered by peer coaches on (a) caregiver and child weight impacted by changes in dietary intake, walking, and screen time; (b) changes in the home environment; and (c) caregiver engagement and satisfaction. The intervention was delivered via 3 core home visits every 4-6 weeks, with additional support via text.ResultsThe majority of caregivers were female (95.2%) and Black (73.7%). Children had median age of 11.1 years and majority were female (57.6%), with a median BMI near the 99th percentile (Mdn 98.8, IQR 3.5) or 118.3% (IQR 35.8) of the 95th percentile for their sex and age. Participants expressed high satisfaction with the program (mean range 96.7-100.0% agreement on satisfaction items). From baseline to post, caregivers' BMI decreased by 1.8% (p = 0.016, r = 0.22), while children's BMI percentile z-score decreased significantly (p = 0.023, r = 0.18) and BMI percent of the 95th percentile remained constant (p = 0.05, r = 0.15). Caregivers and children decreased sugar-sweetened beverage intake (p = 0.026, r = 0.22; p = 0.006, r = 0.23, respectively), reduced presence of soda in the home (p = 0.002, g = 0.43), and decreased screen time (p = 0.046, g = 0.22). Other eating and walking behaviors remained stable for caregivers and child.ConclusionThe Raising Well at Home pilot demonstrated that tailored lifestyle interventions, delivered by peer coaches in the home and via text, are feasible and can improve weight, eating, and environmental measures of caregivers and children with obesity. Future work should determine the effectiveness, sustainability, and scalability of this intervention in sites located across the country.Trial registrationClinicalTrials.gov (NCT04224623). Registered 9 January 2020-retrospectively registered.

Project description:BackgroundInternationally, the implementation of evidence-based healthy eating policies and practices within early childhood education and care (ECEC) settings that encourage children's healthy diet is recommended. Despite the existence of evidence-based healthy eating practices, research indicates that current implementation rates are inadequate. Web-based approaches provide a potentially effective and less costly approach to support ECEC staff with implementing nutrition policies and practices.ObjectiveThe broad aim of this pilot randomized controlled trial is to assess the feasibility of assessing the impact of a web-based program together with health promotion officer (HPO) support on ECEC center implementation of healthy eating policies and practices. Specifically, we seek to describe the completion rate of study evaluation processes (participant consent and data collection rates); examine ECEC center uptake, acceptability, and appropriateness of the intervention and implementation strategies; understand the potential cost of delivering and receiving implementation support strategies; and describe the potential impact of the web-based intervention on the implementation of targeted healthy eating practices among centers in the intervention group.MethodsA 6-month pilot implementation trial using a cluster-randomized controlled trial design was conducted in 22 ECEC centers within the Hunter New England region of New South Wales, Australia. Potentially eligible centers were distributed a recruitment package and telephoned by the research team to assess eligibility and obtain consent. Centers randomly allocated to the intervention group received access to a web-based program, together with HPO support (eg, educational outreach visit and local technical assistance) to implement 5 healthy eating practices. The web-based program incorporated audit with feedback, development of formal implementation blueprints, and educational materials to facilitate improvement in implementation. The centers allocated to the control group received the usual care.ResultsOf the 57 centers approached for the study, 22 (47%) provided consent to participate. Data collection components were completed by 100% (22/22) of the centers. High uptake for implementation strategies provided by HPOs (10/11, 91% to 11/11, 100%) and the web-based program (11/11, 100%) was observed. At follow-up, intervention centers had logged on to the program at an average of 5.18 (SD 2.52) times. The web-based program and implementation support strategies were highly acceptable (10/11, 91% to 11/11, 100%). Implementation of 4 healthy eating practices improved in the intervention group, ranging from 19% (2/11) to 64% (7/11).ConclusionsThis study provides promising pilot data to warrant the conduct of a fully powered implementation trial to assess the impact of the program on ECEC healthy eating practice implementation.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619001158156; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378099.International registered report identifier (irrid)RR2-10.1186/s40814-020-00707-w.

Project description:Background and objectivesMedicare reimbursement policy encourages frequent provider visits to patients with ESRD undergoing hemodialysis. This study sought to determine whether more frequent face-to-face provider (physician and advanced practitioner) visits lead to more procedures and therapeutic interventions aimed at preserving arteriovenous fistulas and grafts, improved vascular access outcomes, and fewer related hospitalizations.Design, setting, participants, & measurementsMultivariable regression was used to evaluate the association between provider (physician and advanced practitioner) visit frequency and interventions aimed at preserving vascular access, vascular access survival, hospitalization for vascular access infection, and outpatient antibiotic use in a cohort of 63,488 Medicare beneficiaries receiving hemodialysis in the United States. Medicare claims were used to identify the type of vascular access used, access-related events, and vascular access failure.ResultsOne additional provider (physician and advanced practitioner) visit per month was associated with a 13% higher odds of receiving an intervention to preserve vascular access (95% confidence interval [95% CI], 12% to 14%) but was not associated with vascular access survival (hazard ratio, 1.01; 95% CI, 0.99 to 1.03). One additional provider visit was associated with a 9% (95% CI, 5% to 14%) lower odds of hospitalization for vascular access infection and a corresponding 9% (95% CI, 5% to 14%) higher odds of outpatient intravenous antibiotic administration. However, the associated changes in absolute probabilities of hospitalization and antibiotic administration were small.ConclusionsMore frequent face-to-face provider (physician and advanced practitioner) visits were associated with more procedures and therapeutic interventions aimed at preserving vascular accesses, but not with prolonged vascular access survival and only a small decrease in hospitalization for vascular access.

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Dataset Information

Influence of a One-Time Web-Based Provider Intervention on Patient-Reported Outcomes After the Well-Child Visit: A Feasibility Study.

Purpose

Methods

Results

Conclusions

Publications

Influence of a One-Time Web-Based Provider Intervention on Patient-Reported Outcomes After the Well-Child Visit: A Feasibility Study.

Similar Datasets

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