P2.J185: Provider and Practice Impacts of the Optimize Feeding QI Project

Background: The Optimize Infant and Toddler Feeding for Obesity Prevention Quality Improvement (QI) Project (“Optimize Feeding”) supports practice changes to sustainably enhance the effectiveness, timeliness, and comprehensiveness of assessment & counseling to promote healthy lifestyle behaviors and healthy growth in children < 2 years during well visits. Between 2020-2022, 3 rounds (R) of the 19-week, team-based, virtual QI collaborative were completed with 37 primary care practices (n=16 [R1]; 11 [R2]; 10 [R3]), resulting in substantial improvements in multiple clinical measures, including pre-/peri-natal risk assessment, weight-for-length assessment, parenting/home lifestyle environment assessment & counseling, and social determinants of health (SDOH) assessment. To obtain additional in-depth information about team experiences during the project, a small number of virtual interviews were conducted by an external evaluation consultant in May-June 2023. This abstract summarizes pediatrician-reported provider- and practice-level program impacts related to 3 primary project aims (Figure 1).

Methods: Confidential interviews were conducted with 5 lead pediatricians who participated in Optimize Feeding at different times/under varied circumstances and responded to invitations to be interviewed. Respondents spanned project rounds (2 R1; 1 R2; 2 R3) and represented diverse practice types, locations, and settings. Each ~30 minute interview followed a semi-structured discussion guide. Transcripts, generated from interview recordings, were content analyzed for key and recurrent themes. Each participant received a $35 e-gift card incentive.

Results: Participants reported impacts associated with Optimize Feeding’s three primary aims. Use of developmentally appropriate resources at point of care: Sustained use of program resources varied, but 3 of 5 pediatricians reported ongoing use of provided resources (eg, parent handouts, motivational interviewing guidance, or SDOH assessments and supportive resources). Knowledge and skills for nutrition/early obesity prevention counseling: Participants characterized themselves as more “confident,” “brave,” and “proactive” in discussions with families around early feeding, food choices, and activity. Improved quality of clinical care and healthcare organizational capacity: Participants described improvements in care content (eg, increased attention to and use of weight-for-length as a starting point for conversation, greater emphasis on responsive feeding at young ages, prioritizing family-informed over physician-directed communication approaches) and workflow (eg, addition of dot phrases to support feeding/nutrition-related anticipatory guidance). See Figure 2 for exemplar quotes describing program impacts for each aim.

Conclusion: One to three years after project participation, pediatricians reported enduring impacts of Optimize Feeding at provider and practice levels, particularly associated with provider confidence in discussions with families and improved clinical care associated with comprehensive approaches to promoting healthy lifestyles/early obesity prevention for children under 2. Limitations include the small sample size; respondent experiences may not reflect those of the larger cohort of participants or practices, although efforts were made to include diverse participant circumstances. Findings will help inform enhancements to future iterations of the Optimize Feeding project and related QI initiatives.