349 - Results of a Novel Quality Improvement Project Targeting Early Obesity Prevention

Poster Number: 349
Publication Number: 349.345

Janice Liebhart, American Academy of Pediatrics, Itasca, IL, United States; Jeanne Lindros, American Academy of Pediatrics, Itasca, IL, United States; Stephanie Womack, American Academy of Pediatrics, Itasca, IL, United States; Sandra Hassink, American Academy of Pediatrics, Wilmington, DE, United States

Background: Studies increasingly support the “first 1000 days,” from conception until age 2, as a critical period for obesity prevention and child health. Recent studies have pointed out gaps in the comprehensiveness of support for healthy lifestyles and obesity prevention in children < 2, delivered by primary care providers (PCPs). The Optimize Infant and Toddler Feeding for Obesity Prevention project is a brief (19-week), virtual team-based quality improvement (QI) collaborative, based on the Model for Improvement, developed to help address these gaps in care.

Objective: To examine results of clinical and balance measures during project rounds 1 and 2 (R1&2) and assess the effects of the pandemic on the QI collaborative.

Design/Methods: R1 was launched in January 2020, paused in mid-March for 10 weeks due to the pandemic, and completed by 16 of 19 teams. R2 was launched in January 2021 and completed by 11 of 12 teams. Key Drivers, specific aims, and trainings/resources were designed to facilitate a tailored, comprehensive approach to care during well visits for all children < 2 years (Figure 1). Teams conduct ongoing improvement cycles and submit data from 20 randomly selected charts at baseline (T1), week 9 (T2), and week 16 (T3) to obtain 10 clinical measures. During R1, T3 was delayed to week 27, without other changes. Teams also submit a 4th “monitoring” data cycle (T4) at week 42. Within post-project surveys, PCPs answered 7 Likert-type questions about the overall impact of participation on care/satisfaction (Response rates: R1=65%; R2=76%). Changes in aggregate clinical measures were analyzed using Fisher’s exact test (p < .025); survey analyses were descriptive.

Results: Across rounds 1 and 2, T1 values were high for 4 of 10 measures (i.e., assessments/counseling for parent concerns & diet/nutrition). By T3, most measures had improved (R1=8; R2=6), and at T4, improvements were generally sustained or increased (R1=7; R2=9) (Table 1). At T4, improvements were consistently noted for assessments of early risks, growth, and social determinants of health (SDOH) and for assessments & counseling for diet/nutrition and the parenting/home environment. SDOH counseling was most challenging to improve but remained improved at T4 during R2. Across rounds, PCPs overwhelmingly did not perceive interference on other aspects of care, and ≥¾ reported moderate to high overall levels of satisfaction (Figure 2).Conclusion(s): Results support consistent, sustained improvements to support a comprehensive approach to early obesity prevention across 2 rounds of a novel QI project, conducted during the pandemic.
Figure 1. Key Drivers and Global and Specific Aims for the Optimize Infant & Toddler Feeding for Obesity Prevention Collaborative.
Table 1. Comparison of the Percentage of All Submitted Charts Meeting Measurement Standards at Baseline (T1) Versus at Time 2, Time 3, and Time 4 for Teams Participating During Project Rounds 1 and 2. Values are percentages with ns in parentheses.a