Cygan Heide, Reed Monique, Lui Karen, Mullen Mary
1 Rush University, Chicago, IL, USA.
Clin Pediatr (Phila). 2018 Jun;57(6):727-732. doi: 10.1177/0009922817734357. Epub 2017 Oct 11.
One-third of children in the United States are overweight or obese. Comorbidities continue into adulthood if a healthy weight is not established. While expert guidelines for management of this condition are recognized, provider adherence to guidelines is lacking. The purpose of this quality improvement project was to evaluate the effectiveness of the chronic care model (CCM) on improving primary care provider identification, prevention, and management of childhood overweight and obesity. A pre- and postintervention chart audit was completed to evaluate documentation of 20 assessment measures included in expert guidelines. A chi-square analysis was conducted to assess differences. Statistically significant improvements were found in documentation of parental obesity, family medical history, sleep assessment, endocrine assessment, and weight classification as a diagnosis. Use of the CCM had a positive impact on provider adherence to expert guidelines. Furthermore, not all aspects of the CCM must be used to see statistically significant improvements.
美国三分之一的儿童超重或肥胖。如果未能确立健康体重，这些儿童的共病情况会持续到成年期。尽管公认有针对这种情况的专家管理指南，但医疗服务提供者对指南的遵循情况却很欠缺。这个质量改进项目的目的是评估慢性病护理模式（CCM）在改善初级保健提供者对儿童超重和肥胖的识别、预防及管理方面的有效性。开展了一项干预前后的图表审核，以评估专家指南中包含的20项评估措施的记录情况。进行了卡方分析以评估差异。在父母肥胖、家族病史、睡眠评估、内分泌评估以及将体重分类作为诊断的记录方面发现了具有统计学意义的改善。CCM的使用对医疗服务提供者遵循专家指南产生了积极影响。此外，并非必须采用CCM的所有方面才能看到具有统计学意义的改善。
