Zenlea I S, Milliren C, Herel S, Thomaseo Burton E, Askins N, Ludwig D S, Rhodes E T
Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA.
Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
Clin Obes. 2016 Oct;6(5):313-20. doi: 10.1111/cob.12156. Epub 2016 Aug 4.
We aimed to reduce attrition of newly referred patients in a paediatric weight management programme by implementing an orientation to address families' expectations and screen for and support behavioural and mental health problems and psychosocial stressors at programme outset. Orientation impact was monitored with run charts with percentages of scheduled encounters completed. Long-term impact was assessed by comparing patients in the initial 6 months of the orientation to a baseline group of referred patients during the same 6-month time interval in the prior year (Pre-Orientation Group). The outcome measure was programme attrition within 15 months. Groups were compared using Kaplan-Meier survival analysis and Cox proportional hazards regression modelling. Patients in the Orientation Group had a 23% increased odds of attrition compared to patients in the Pre-Orientation group (adjusted Hazard ratio, aHR 1.23; 95% confidence interval, CI: 1.01, 1.51) and shorter median duration of follow-up (2.0 vs. 2.9 months, P = 0.004). An increase in body mass index z-score of 1 unit resulted in a nearly fivefold increased odds of attrition (aHR 5.24; 95% CI: 2.95, 9.3). An orientation for new patients did not reduce attrition within 15 months. We suggest that ongoing retention strategies should be embedded into the treatment phase of the programme.
我们旨在通过在项目开始时实施一项指导措施来解决家庭期望、筛查并支持行为和心理健康问题以及社会心理压力源，从而减少儿科体重管理项目中新转诊患者的失访情况。通过运行图监测指导措施的影响，运行图显示已完成的预定会诊百分比。通过将指导措施实施最初6个月内的患者与上一年同一6个月时间间隔内的转诊患者基线组（指导措施实施前组）进行比较，评估长期影响。结果指标是15个月内的项目失访情况。使用Kaplan-Meier生存分析和Cox比例风险回归模型对各组进行比较。与指导措施实施前组的患者相比，指导措施组的患者失访几率增加了23%（调整后风险比，aHR 1.23；95%置信区间，CI：1.01，1.51），且中位随访时间更短（2.0个月对2.9个月，P = 0.004）。体重指数z评分每增加1个单位，失访几率增加近五倍（aHR 5.24；95%CI：2.95，9.3）。对新患者的指导措施在15个月内并未减少失访情况。我们建议应将持续的留存策略纳入项目的治疗阶段。
