Published online May 26, 2009
PEDIATRICS Vol. 123 Supplement June 2009, pp. S308-S316 (doi:10.1542/peds.2008-2780J)
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SUPPLEMENT ARTICLE


Small Steps to Health: Building Sustainable Partnerships in Pediatric Obesity Care

Mo Pomietto, MN, RNa, Alicia Dixon Docter, MS, RDa, Nicole Van Borkulo, Medb, Lorrie Alfonsi, LSWc, James Krieger, MD, MPHc,d and Lenna L. Liu, MD, MPHe,f

a Department of Clinical Nutrition
e Division of General Pediatrics, Seattle Children's Hospital, Seattle Washington
b National Initiative for Children's Healthcare Quality, Cambridge, Massachusetts
c Public Health–Seattle & King County, Seattle, Washington
d Departments of Medicine
f Pediatrics, University of Washington, Seattle, Washington

BACKGROUND. Given the prevalence of childhood obesity and the limited support for preventing and managing obesity in primary care settings, the Seattle Children's Hospital's Children's Obesity Action Team has partnered with Steps to Health King County to develop a pediatric obesity quality-improvement project.

METHODS. Primary care clinics joined year-long quality-improvement collaboratives to integrate obesity prevention and management into the clinic setting by using the chronic-disease model. Sustainability was enhanced through integration at multiple levels by emphasizing small, consistent behavior changes and self-regulation of eating/feeding practices with children, teenagers, and families; building local community partnerships; and encouraging broader advocacy and policy change. Cultural competency and attention to disparities were integrated into quality-improvement efforts.

RESULTS. Participating clinics were able to increase BMI measurement and weight classification; integrate management of overweight/obese children and family and self-management support; and grow community collaborations. Over the course of 4 years, this project grew from a local effort involving 3 clinics to a statewide program recently adopted by the Washington State Department of Health.

CONCLUSIONS. This model can be used by other states/regions to develop pediatric obesity quality-improvement programs to support the assessment, prevention, and management of childhood obesity. Furthermore, these health care efforts can be integrated into broader community-wide childhood-obesity action plans.

Key Words: overweight • obesity • quality improvement • child • primary care • chronic care model • community oriented primary care

Abbreviations: COAT—Children's Obesity Action Team • STEPS—Steps to Health King County • QI—quality improvement • NICHQ—National Initiative of Children's Healthcare Quality • CHIC—Children's Health Improvement Collaborative • CDEMS—Chronic Disease Electronic Management System

Accepted Feb 18, 2009.


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