Published online May 26, 2009
PEDIATRICS Vol. 123 Supplement June 2009, pp. S258-S266 (doi:10.1542/peds.2008-2780C)
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SUPPLEMENT ARTICLE


Impact of a Primary Care Intervention on Physician Practice and Patient and Family Behavior: Keep ME Healthy—The Maine Youth Overweight Collaborative

Michele Polacsek, PHD, MHSa,b, Joan Orr, CHESa, Lisa Letourneau, MD, MPHc, Victoria Rogers, MDd, Robert Holmberg, MD, MPHe, Karen O'Rourke, MPHa,f, Cindy Hannon, MSWb, Kenneth A. Lombard, MDd and Steven L. Gortmaker, PHDb

a Maine Harvard Prevention Research Center, Augusta, Maine
b Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts
c MaineHealth, Portland, Maine
d The Kid's Coop, Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
e Norumbega Pediatrics, Bangor, Maine
f Maine Center for Public Health, Augusta, Maine

OBJECTIVE. To evaluate the effect of a pediatric primary care–based intervention, on improved clinical decision support and family management of risk behaviors for childhood overweight.

METHODS. An experimental field trial was conducted with 12 intervention sites in urban and rural areas of Maine and nonrandomized control sites. Change was assessed by using clinical and parent measures from 9 intervention and 10 control sites before and during the Maine Youth Overweight Collaborative intervention. Longitudinal information was collected from chart audits of patients aged 5–18 years (n = 600), systematic samples of parents collected before (n = 346) and during (n = 386) the intervention in 12 sites, and systematic samples of parents in 9 intervention (n = 235) and 10 control (n = 304) sites collected during the intervention. Surveys of health care providers (n = 14 and 17) before and during the intervention were also collected. Teams worked over 18 months to implement improvements in clinical decision support, including tracking BMI percentiles, identification of overweight patients, appropriate laboratory tests, counseling of families and patients use of a behavioral screening tool, and other improvements following the chronic-care model targeting patients aged 5 to 18 and their families.

RESULTS. Large changes occurred in clinical practice from before to during the Maine Youth Overweight Collaborative: increases in assessment of BMI (38%–94%), BMI percentile for age and gender (25%–89%), use of the 5-2-1-0 behavioral screening tool (0%–82%), and weight classification (19%–75%). Parent surveys indicated improvements in providers’ behavior and rates of counseling. Intervention providers reported improvements in knowledge, attitudes, self-efficacy, and practice.

CONCLUSIONS. The Maine Youth Overweight Collaborative intervention improved clinical decision support and family management of risk behaviors, indicating a promising primary care–based approach to address overweight risk among children and youth.

Key Words: obesity • overweight • child • primary care • chronic-care model

Abbreviations: MYOC—Maine Youth Overweight Collaborative • NICHQ—National Initiative for Children's Healthcare Quality • CDC—Centers for Disease Control and Prevention • TV—television • OR—odds ratio • CI—confidence interval

Accepted Feb 18, 2009.


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