P2.J194: Promoting Healthy Weight in a Primary Care Setting: A Measurement of Impact Following Implementation of Guideline-Directed Interventions in a Pediatric Resident Clinic

Purpose/Objectives: The obesity epidemic affects approximately 20% of the US pediatric population (1). Primary Care Providers are critical in managing patients with obesity. However, many barriers exist to providing adequate care, including provider training and waning confidence in management strategies (2,3). Our Quality Improvement (QI) project aimed to increase resident self-reported competency to apply effective management strategies in the outpatient setting by implementing evidence-based interventions for treating obese pediatric patients.

Design/Methods: Surveys assessing self-reported competence in the different management aspects of patients with obesity in the outpatient setting were dispersed ("pre-survey") to our University of Tennessee Health Sciences Center (UTHSC) pediatric and med-peds residents. Then, we implemented aids designed to help each management aspect in our primary care clinic. The aids were:
1) Instruction on respectful language that avoids invoking medical or social weight stigma
2) Guideline-directed algorithm informing obesity-related comorbidity management (See Figure 1)
3) Guideline-directed EMR dot phrases for efficient charting of essential information.
4) Patient and provider forms that help facilitate shared decision-making for implementing evidence-based, practical, and family-specific healthy weight goals.
We categorized respondents into residents and interns, distributing pre-surveys to residents before the 2023-2024 academic year and to interns at the start of the 2023-2024 academic year. After 90 days, we redistributed the same survey (post-survey). We recorded the number of 'yes' responses on the pre-and post-survey and calculated the differences. A normal data distribution was assumed based on the Shapiro-Wilk Test calculation (p-value = 0.7771). We assessed the significance of response differences using a paired t-test.

Results: Of 125 possible respondents, 69 residents and 21 interns responded to the surveys. The intern data was not analyzed because the sample size was too small for generalizability and significant statistical power.
There were increases in yes responses between the pre- and post-survey. The most significant increase (36.2%) was to the question, "I feel comfortable discussing guideline-directed diagnosis and treatment sequelae of obesity." The results of the paired t-test overall indicated a significant increase between yes responses before (M = 0.5, SD = 0.3) and after (M=0.7, SD=0.2), t(5) = 4.4, p = 0.007) introduction of the aids.

Conclusion/Discussion: A barrier to treating pediatric patients with obesity is that many pediatricians do not feel they have effective management strategies. During the implementation of our QI project, resident self-reported competency increased in pediatric obesity management in our outpatient clinic. The most significant increases were related to the algorithm for managing obesity-related complications. While limited by sample size and generalizability, this study underscores the need for further efforts across pediatric residency programs to improve residents' preparedness in caring for pediatric patients with obesity.