临床医生行为与学龄儿童体重变化的关联。
Association of Clinician Behaviors and Weight Change in School-Aged Children.
机构信息
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas; Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Pediatrics, Children's Medical Center, Dallas, Texas.
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Pediatrics, Children's Medical Center, Dallas, Texas; Department of Pediatrics, Texas Children's Hospital, Houston, Texas.
出版信息
Am J Prev Med. 2019 Sep;57(3):384-393. doi: 10.1016/j.amepre.2019.04.029. Epub 2019 Aug 1.
INTRODUCTION
This study uses clinical practice data to determine whether recommended weight management clinician behaviors are associated with weight status improvement in children aged 6-12 years who are overweight or obese.
METHODS
Electronic health record data (2009-2014) from 52 clinics were used. Weight status was examined from 1 visit to the next as dichotomous improvement (versus worsening or no change) and change in percentage overweight (over sex/age-specific BMI). The primary predictor was a clinician behavior variable denoting attention to high BMI alone or with assessment of medical risk/comorbidities and was defined using combinations of diagnostic codes and electronic health record orders. Covariates included time between visits and medications associated with weight gain or loss. Adjusted multilevel regression models examined the association of the clinician behavior variable with weight status improvement. Analyses were conducted from 2015 to 2018.
RESULTS
Children (n=7,205) had a mean age of 8.9 years; 45.5% were overweight, 54.5% obese, and 81.1% publicly insured. For 62% of overweight children, and 38%, 21%, and 11% of those in obesity classes 1-3, respectively, no attention to high BMI/medical risk assessment at any visit was identified. Children with evidence of clinician attention to high BMI alone and who underwent a medical risk assessment had significantly greater AOR of improvement in percentage of BMI and percentage of BMI change: BMI alone, AOR=1.2 (p<0.001) and β= -0.3 (p>0.05); BMI/medical risk, AOR=1.2 and β= -0.5 (both p<0.001). Other factors associated with weight status improvement included prescription medications (1 or more prescriptions associated with either weight loss or none associated with weight gain) and fewer months between visits.
CONCLUSIONS
This is the first study to use electronic health record data to demonstrate that widely recommended clinician behaviors are associated with weight status improvement in children aged 6-12 years who are overweight or obese.
简介
本研究利用临床实践数据，确定在超重或肥胖的 6-12 岁儿童中，推荐的体重管理临床医生行为是否与体重状况的改善有关。
方法
使用 52 个诊所的电子健康记录数据（2009-2014 年）。从一次就诊到下一次就诊，将体重状况检查为改善（与恶化或无变化相比）和超重百分比变化（按性别/年龄特定 BMI 计算）。主要预测因子是一个临床医生行为变量，表示仅关注高 BMI，或同时评估医疗风险/合并症，并使用诊断代码和电子健康记录订单的组合来定义。协变量包括就诊时间间隔和与体重增加或减轻相关的药物。调整后的多水平回归模型检查了临床医生行为变量与体重状况改善的关联。分析于 2015 年至 2018 年进行。
结果
儿童（n=7205）的平均年龄为 8.9 岁；45.5%超重，54.5%肥胖，81.1%有公共保险。在 62%的超重儿童中，分别有 38%、21%和 11%的肥胖 1 级、2 级和 3 级儿童在任何就诊时都没有注意到高 BMI/医疗风险评估。有临床医生关注高 BMI 单独和进行医疗风险评估证据的儿童，其 BMI 百分比和 BMI 变化百分比改善的优势比（AOR）显著更高：BMI 单独，AOR=1.2（p<0.001）和β= -0.3（p>0.05）；BMI/医疗风险，AOR=1.2 和β= -0.5（均 p<0.001）。与体重状况改善相关的其他因素包括处方药物（1 种或多种与体重减轻相关的药物或与体重增加无关的药物）和就诊时间间隔较短。
结论
这是第一项使用电子健康记录数据的研究，表明广泛推荐的临床医生行为与 6-12 岁超重或肥胖儿童的体重状况改善有关。
Zotero 插件