591 - Quality Improvement Focused Training for Pragmatic Implementation of Obesity Treatment in Primary Care

Publication Number: 4579.591

Jeremiah Salmon, American Academy of Pediatrics, Itasca, IL, United States; E. Jeanne Lindros, American Academy of Pediatrics, Itasca, IL, United States; Stephen R. Cook, Center for Healthy Weight & Nutrition / NCH, Columbus, OH, United States; Amanda E. Staiano, Pennington Biomedical Research Center, Baton Rouge, LA, United States; Sandra G. Hassink, American Academy of Pediatrics, Wilmington, DE, United States; Victoria Rogers, AAP, Saco, ME, United States; Denise Wilfley, Washington University in St. Louis School of Medicine, St Louis, MO, United States

Background: Pediatric primary care providers were trained in delivering an enhanced standard of care (eSOC), (Fig 1), as part of a large pragmatic, comparative effectiveness trial (2019-2024), focused on obesity treatment. eSOC was compared with eSOC plus Family-Based Behavioral Treatment (eSOC+FBT), an evidence-based program delivering intensive health behavior and lifestyle treatment with trained interventionists. Previous studies suggest the important role that providers play in obesity treatment and potential for eSOC.

Objective: Identify a pragmatic approach to addressing obesity in primary care.

Design/Methods: To become a verified study provider, pediatricians and family medicine providers (MD/DO, NP/PA, etc.) completed eSOC Core Curriculum (Table 1), covering key topics such as medical management of obesity, behavioral counseling, and practical workflow considerations with a focus on implementation of national guideline concordant care. Once completed, providers/clinic teams were encouraged to join a virtual learning collaborative (VLC), which leveraged the ECHO model, combining didactic sessions and case-based learning. Later the VLC used the Model for Improvement framework, which uses 3 fundamental questions (i.e., what are we trying to accomplish, how will we know that a change is an improvement, and what change can we make that will result in improvement) along with plan-do-study-act (PDSA) cycles to drive practice change. In addition to QI activities and peer learning, Providers received a copy of Next Steps: A Practitioner's Guide of Themed Follow-up Visits to Help Patients Achieve a Healthy Weight.

Results: The Core Curriculum was completed by 166 providers and clinical team members (Table 2). The ongoing training and VLC, broken into 4 phases (Table 3), had consistent participation throughout the intervention with 78% completing at least 1 additional phase beyond the initial required training, although provider engagement decreased over time. Providers reported changes to strategies they implement in practice (75%) and what they do in practice (80%). Reported changes included improved use of motivational interviewing, targeted comorbidity screening, monitoring labs more closely, and individualizing care among other changes based on the trainings and virtual learning collaborative.

Conclusion(s): Structured virtual eSOC trainings, virtual learning collaboratives, and peer learning can build clinical capacity and provider self-efficacy to deliver guideline concordant obesity care and ultimately increase access to evidence-based and effective obesity treatment in pediatric primary care obesity management.

Figure 1. eSOC Approach


Table 1. eSOC Core Curriculum and Ongoing Training


Tables 2 & 3. eSOC Core Training Completion and Ongoing Participation