O3026: Testing Obesity Guideline Implementation at the Point-of-care Using an Interoperable Clinical Decision Support Resource

Background: Current primary care practice for children with obesity is highly variable and experience based. Clinical practice guidelines (CPG) can improve clinical care and outcomes but are underutilized. Integration of the clinical recommendations within clinical workflows may effectively bridge the gap between evidence-based guidelines and frontline utilization. To date, this translation has been fraught with barriers such as: high resource cost, workflow design issues, and institutional bureaucracy. In this project, we aimed to develop and implement a sharable and interoperable tool for rapidly integrating CPG recommendations into clinical workflows that can be quickly and easily implemented into most primary care and/or health care system.

Methods: The Institute for Healthy Childhood Weight partnered with Curbside Health, Inc. to translate the newly released 2023 American Academy of Pediatrics CPG for the Evaluation and Treatment of Children and Adolescents with Obesity from a >100-page document into an actionable point-of-care clinical pathway. Within the Curbside Health platform, the pathway uses resources from the Fast Healthcare Interoperability Resources (FHIR) interoperability standard to prefill patient-specific data and then algorithmically determines the next best actions for the clinicians including order placement, referrals, patient education, and more (Figure 1). Each of these resources is specific to the particular patient’s characteristics, providing tailored recommendations at the point-of-care. Additionally, the pathway is customizable, allowing for institutional governance, and includes outcome analytics, version control, and can be continuously updated in real-time without requiring hospital information service resources.
Primary care practices, federally qualified health centers, and pediatric health care systems are being actively recruited to implement, test, and provide feedback to iteratively improve the pathway. Implementation of the pathway can occur through the inclusion of a simple weblink (no data transfer), a dynamic link (minimal, deidentified data transfer via link), or full FHIR integration within the EHR using an application programming interface (Figure 2). Those providers and/or centers participating in testing receive free access in exchange for direct feedback and reporting on the pathway.

Results: Utilization data is included in the Curbside Health web platform and will allow the Institute to monitor the number of unique users (new & returning), pageviews, type of access (desktop vs mobile), location , and frequency of modifications to the pathway by users. The Institute will also gather information and feedback on the design of the pathway, associated recommendations, and the linked/suggested resources.

Conclusion: The pathway has the potential to address existing practice and provider-level barriers. Utilization of the pathway at the point of care could greatly increase the uptake of the new CPG. Utilization data collected through the Curbside Health web platform, as well as the information and feedback provided by users, will offer insight into the pathway’s impact on clinical barriers, documentation burden, and uptake of the new CPG.