O1031: Improved Clinical Measures and Assessed Capacity for Primary Care Sites Participating in a Pilot Collaborative to Support Evidence-based Treatment Visits for Pediatric Overweight or Obesity

Purpose/Objectives: The 2023 pediatric obesity clinical practice guideline (CPG) recommends that primary care teams (PCTs) comprehensively evaluate patients ages 2-18 with overweight (OV) or obesity (OB) for comorbidities and offer them multicomponent, family-based, intensive health behavior & lifestyle treatment, ideally >=26 contact hours over 3-12 months. PCTs often lack local resources to help provide intensive treatment, so there is an urgent need to help them build capacity. A 33-week team-based, virtual pilot quality improvement (QI) collaborative was launched in April 2023 to support PCTs in offering OV/OB treatment visits. The pilot integrates new CPG-focused resources, including a capacity assessment tool, training modules, and a change package of clinical & patient-facing tools. The purpose of this abstract is to assess improvements in clinical measures and capacity during the collaborative.

Design/Methods: PCTs submit 3 cycles of clinical data during the collaborative (T1-T3), plus 1 monitoring cycle, 4 months later (T4). Data are based on 15 randomly selected charts from OV/OB treatment visits and used to calculate 7 evaluation-focused measures (e.g., BMI, labs, medical exam) and 8 treatment-focused measures (e.g., setting behavioral goals, discussing adjuncts). (Table) PCTs also complete a capacity assessment at T1, T3, and T4. Questions include the % staff trained in 6 topics (e.g., CPG, stigma) and whether (Y/N) designated staff roles and electronic health record (EHR) space exists for 12 aspects of evaluation and 14 aspects of treatment. PCTs also report the implementation stage (4 ordered levels) for 7 systems supporting treatment visit operations (e.g., tracking patients, billing), and 8 systems supporting long-term maintenance (e.g., assessing retention, costs/revenues). At T3 and T4, PCTs also report whether they had acquired new treatment partners (e.g., RDs, subspecialists, multidisciplinary programs) or improved the availability/intensity of treatment visits. Aggregate clinical measures at T2 and T3 are compared with baseline values, using Fisher’s Exact Test (corrected p<.025). T3 and T1 capacity assessments are compared (p <.05) using McNemar (2-categories) or paired t-tests (indices). Implementation stages were dichotomized into low and high levels.

Results: PCTs at 15 diverse practice sites participated. By T3, PCTs improved 3 evaluation-focused and 4 treatment-focused clinical measures (Table). PCTs also improved multiple aspects of capacity, including the % staff trained in each topic and the number of designated evaluation- and treatment-focused team roles, although EHR space was unimproved (data not shown). By T3, PCTs also increased implementation of 5 systems to support operations and 1 to support maintenance (Figure). Additionally, 67% of PCTs gained treatment partners, and 87% improved treatment visit access/intensity. T4 results are pending.

Conclusion/Discussion: Despite the complexity of recommended care, by the end of the 33-week collaborative, PCTs improved 7 of 15 clinical measures and built substantial (operational) capacity for OV/OB treatment visits. Sustainability results are expected and will be included.