TY - JOUR
T1 - Association of Clinician Behaviors and Weight Change in School-Aged Children
AU - Turer, Christy B.
AU - Barlow, Sarah E.
AU - Sarwer, David B.
AU - Adamson, Brian
AU - Sanders, Joanne
AU - Ahn, Chul
AU - Zhang, Song
AU - Flores, Glenn
AU - Skinner, Celette Sugg
N1 - Funding Information:
This study was supported in part by Awards number K23HL118152 and number R03HL144811 from the National Heart, Lung, and Blood Institute to Dr. Turer, Award number R21DK114764 from the National Institute of Diabetes and Digestive and Kidney Diseases to Dr. Turer, Award number UL1TR001105 from the National Center for Advancing Translational Sciences of NIH, and Award number R24HS022418 from the Agency for Healthcare Research and Quality .
Funding Information:
We would like to thank Children's Medical Center Dallas, the flagship hospital of Children's Health; Children's Health Pediatric Group practices; Nancy Kelly and the Children's Medical Center's Continuity-of-Care Clinic; Hua Lin, Christopher Menzies, and Taylor Gheen for their assistance in obtaining the study data. We thank Olga Gupta and Michael Bowen for their assistance coding and developing consensus regarding medications associated with weight loss and weight gain. We also thank Rita Mangione-Smith for providing SAS code for the pediatric medical-complexity algorithm. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, or Agency for Healthcare Research and Quality. This study was supported in part by Awards number K23HL118152 and number R03HL144811 from the National Heart, Lung, and Blood Institute to Dr. Turer, Award number R21DK114764 from the National Institute of Diabetes and Digestive and Kidney Diseases to Dr. Turer, Award number UL1TR001105 from the National Center for Advancing Translational Sciences of NIH, and Award number R24HS022418 from the Agency for Healthcare Research and Quality. CBT designed the study, obtained funding, supervised EHR data collection, assisted with analysis and interpretation of data, and drafted the manuscript; SEB assisted with the study design, analysis, clinical interpretation of data, and critically revised the manuscript; DBS assisted with analysis and interpretation of data, and critically revised the manuscript; BA assisted with the study's EHR data algorithm development, refinement, building analytic variables, methods communication (ensuring section accurately depicts study protocol and analysis), and critically revised the manuscript; JS oversaw data management, work performed by BA, and critically revised the manuscript; CA and SZ assisted with the study's statistical design and oversaw analysis of the data; GF oversaw the initial study design, assisted with interpretation of data, and critically revised the manuscript; CSS oversaw the final study design, assisted with analysis and data interpretation, and critically revised the manuscript. All authors approved the final manuscript as submitted. David Sarwer declares consulting relationships with BARONova, Merz, and Novo Nordisk. No other financial disclosures were reported.
Publisher Copyright:
© 2019 American Journal of Preventive Medicine
PY - 2019/9
Y1 - 2019/9
N2 - Introduction: This study uses clinical practice data to determine whether recommended weight management clinician behaviors are associated with weight status improvement in children aged 6–12 years who are overweight or obese. Methods: Electronic health record data (2009–2014) from 52 clinics were used. Weight status was examined from 1 visit to the next as dichotomous improvement (versus worsening or no change) and change in percentage overweight (over sex/age-specific BMI95). The primary predictor was a clinician behavior variable denoting attention to high BMI alone or with assessment of medical risk/comorbidities and was defined using combinations of diagnostic codes and electronic health record orders. Covariates included time between visits and medications associated with weight gain or loss. Adjusted multilevel regression models examined the association of the clinician behavior variable with weight status improvement. Analyses were conducted from 2015 to 2018. Results: Children (n=7,205) had a mean age of 8.9 years; 45.5% were overweight, 54.5% obese, and 81.1% publicly insured. For 62% of overweight children, and 38%, 21%, and 11% of those in obesity classes 1–3, respectively, no attention to high BMI/medical risk assessment at any visit was identified. Children with evidence of clinician attention to high BMI alone and who underwent a medical risk assessment had significantly greater AOR of improvement in percentage of BMI95 and percentage of BMI95 change: BMI alone, AOR=1.2 (p<0.001) and β= −0.3 (p>0.05); BMI/medical risk, AOR=1.2 and β= −0.5 (both p<0.001). Other factors associated with weight status improvement included prescription medications (1 or more prescriptions associated with either weight loss or none associated with weight gain) and fewer months between visits. Conclusions: This is the first study to use electronic health record data to demonstrate that widely recommended clinician behaviors are associated with weight status improvement in children aged 6–12 years who are overweight or obese.
AB - Introduction: This study uses clinical practice data to determine whether recommended weight management clinician behaviors are associated with weight status improvement in children aged 6–12 years who are overweight or obese. Methods: Electronic health record data (2009–2014) from 52 clinics were used. Weight status was examined from 1 visit to the next as dichotomous improvement (versus worsening or no change) and change in percentage overweight (over sex/age-specific BMI95). The primary predictor was a clinician behavior variable denoting attention to high BMI alone or with assessment of medical risk/comorbidities and was defined using combinations of diagnostic codes and electronic health record orders. Covariates included time between visits and medications associated with weight gain or loss. Adjusted multilevel regression models examined the association of the clinician behavior variable with weight status improvement. Analyses were conducted from 2015 to 2018. Results: Children (n=7,205) had a mean age of 8.9 years; 45.5% were overweight, 54.5% obese, and 81.1% publicly insured. For 62% of overweight children, and 38%, 21%, and 11% of those in obesity classes 1–3, respectively, no attention to high BMI/medical risk assessment at any visit was identified. Children with evidence of clinician attention to high BMI alone and who underwent a medical risk assessment had significantly greater AOR of improvement in percentage of BMI95 and percentage of BMI95 change: BMI alone, AOR=1.2 (p<0.001) and β= −0.3 (p>0.05); BMI/medical risk, AOR=1.2 and β= −0.5 (both p<0.001). Other factors associated with weight status improvement included prescription medications (1 or more prescriptions associated with either weight loss or none associated with weight gain) and fewer months between visits. Conclusions: This is the first study to use electronic health record data to demonstrate that widely recommended clinician behaviors are associated with weight status improvement in children aged 6–12 years who are overweight or obese.
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U2 - 10.1016/j.amepre.2019.04.029
DO - 10.1016/j.amepre.2019.04.029
M3 - Article
C2 - 31377089
AN - SCOPUS:85069975117
SN - 0749-3797
VL - 57
SP - 384
EP - 393
JO - American Journal of Preventive Medicine
JF - American Journal of Preventive Medicine
IS - 3
ER -