Golisano Children's Hospital, Strong Memorial Hospital, University of Rochester, Rochester, NY, USA.
J Pediatr Health Care. 2011 Jan-Feb;25(1):31-7. doi: 10.1016/j.pedhc.2010.04.006.
Obesity in children and adolescents has become an epidemic in the United States. The ramifications of obesity at a young age are longstanding and affect physical health, emotional health, and the economics of the health care industry. The Strong Pediatric Practice at Golisano Children's Hospital is a large inner-city practice serving more than 14,000 urban children and adolescents, the majority living below the poverty level. The Obesity Task Force, which comprises four nurse practitioners, two nurses, a nutritionist, and one physician, developed and implemented the "Passport to Health" tool in an attempt to encourage providers to assess and work with families around the issues of weight and activity, a need that was identified through chart audits. The Passport to Health supports the policy statements on prevention of overweight and obesity by the Centers for Disease Control and Prevention, National Association of Pediatric Nurse Practitioners, and American Academy of Pediatrics. Quality assurance standards for managed care that mandate body mass index (BMI) assessment and nutrition counseling in all children and adolescents also is supported by this tool. The Passport to Health also provides the same message as a current community initiative in the Rochester area that has received widespread media coverage. This tool includes a visual color-coded indicator of the child's BMI status and a synopsis of specific healthy eating and activity goals, and it permits an individualized goal to be established. The Passport to Health translates information that the provider knows about the BMI status into information that the family and child can embrace and understand. Chart audits as well as exit interviews have demonstrated that use of the Passport to Health has increased the assessment, identification, and counseling by providers in relation to healthy eating and activity. Chart audits found that nurse practitioners embraced this practice change more readily than did other providers. We also found that the use of the Passport to Health has increased the involvement of the child and adolescent in discussions about weight and activity status. Recommendations to encourage future practice changes have been established and will be implemented. The changes include intensive education with providers who were less likely to utilize the Passport to Health tool. The Passport to Health could be implemented easily in any pediatric practice setting.
儿童和青少年肥胖已成为美国的一种流行病。年轻时肥胖的后果是长期的，会影响身体健康、心理健康和医疗保健行业的经济状况。戈利萨诺儿童医院的强大儿科实践是一家大型市内实践，为超过 14000 名城市儿童和青少年提供服务，其中大多数生活在贫困线以下。由四名执业护士、两名护士、一名营养师和一名医生组成的肥胖工作组开发并实施了“健康护照”工具，试图鼓励提供者评估并与家庭一起解决体重和活动问题，这一需求是通过图表审核确定的。《健康护照》支持疾病控制与预防中心、美国儿科护士从业者协会和美国儿科学会关于预防超重和肥胖的政策声明。该工具还支持管理式医疗保健的质量保证标准，该标准要求对所有儿童和青少年进行体重指数（BMI）评估和营养咨询。《健康护照》还提供了罗切斯特地区当前社区倡议的相同信息，该倡议得到了广泛的媒体报道。该工具包括儿童 BMI 状况的视觉彩色编码指标和具体健康饮食和活动目标的摘要，并允许确定个性化目标。《健康护照》将提供者了解的 BMI 状况信息转化为家庭和儿童可以接受和理解的信息。图表审核和离职访谈表明，使用《健康护照》增加了提供者在健康饮食和活动方面的评估、识别和咨询。图表审核发现，执业护士比其他提供者更愿意接受这种实践上的改变。我们还发现，使用《健康护照》增加了儿童和青少年参与有关体重和活动状况讨论的程度。已经制定了鼓励未来实践变革的建议，并将予以实施。这些变化包括对不太可能使用《健康护照》工具的提供者进行强化教育。《健康护照》可以很容易地在任何儿科实践环境中实施。
