Kimberly Joerg, DNP
Assessment and Early Identification of Childhood Overweight in Pediatric Primary Care
The prevalence of pediatric obesity continues to grow. The role of the pediatric primary care provider in the assessment and early identification of overweight children is paramount to appropriate intervention. The purpose of this quality improvement project was to evaluate the effectiveness of an evidence-based initiative on the behaviors of pediatric practitioners in a primary care setting. The Healthy Eating and Activity Together (HEAT) initiative from the National Association of Pediatric Nurse Practitioners was utilized as the clinical practice guideline. Attitudes regarding clinical practice guidelines were also explored. The project was introduced in two phases within a single pediatric practice using a modified stepped wedge design. The data was collected utilizing a revised attitude survey and a student developed chart checklist instrument. Pre-intervention data was collected before the educational intervention and individual performance feedback and repeated at two post intervention time points. Six providers participated in the study. Results of the study showed a statistically significant difference between the pre-intervention mean scores of the percentage of items documented and the first post-intervention chart review for the group of providers t(126)=2.082, p=.039, d=0.37, 95% CI [0.2, 6.9]. The intervention was associated with a 3.5% increase in the percentage of items documented. There was not a statistically significant difference between mean score of the percentage of items documented between the pre-intervention time point and the second post-intervention t(123) =1.686, p=.094, d=0.30, 95%CI [-0.6, 7.0] . Overall, the attitudes of the providers were positive regarding clinical practice guidelines. Clinical practice guidelines were found to be helpful and accessible by the providers. The use of an educational intervention and individual performance feedback to increase documentation of recommended parameters regarding childhood obesity was supported at the first post-intervention time point by this project. Although there was not a significant difference at the second time point post educational intervention, future research may examine the effectiveness of interventions over extended time points. The incorporation of documentation parameters as recommended by the HEAT clinical practice guideline might increase consistency in practice among providers regarding early identification and management of childhood in the primary care setting.