O3030: Testing a Resource Package to support Implementation of an Evidence-based Intensive Health Behavior and Lifestyle Intervention Within Primary Care Settings

Purpose/Objectives: Addressing pediatric obesity is a high priority within primary care settings. However, providers/practices often lack sufficient training or community resources to meet patient needs for intensive health behavior and lifestyle treatment (IHBLT), consistent with the 2023 American Academy of Pediatrics (AAP) Clinical Practice Guideline. As part of the Childhood Obesity Research Demonstration 3.0 project (CORD 3.0), Massachusetts General Hospital and the AAP Institute for Healthy Childhood Weight conducted a project to refine and test a resource package that included structured quality improvement (QI) activities, to support primary care practices in implementing an onsite Healthy Weight Clinic (HWC). The HWC is a multi-component, evidence- and family-based IHBLT intervention, comprised of clinic visits, group sessions, telephone checks (>=30 contact hours over 12 months), for children ages 2-18 with overweight or obesity. The objective of this analysis was to examine team capacity-building/implementation progress during the QI project.

Design/Methods: Four primary care practices were recruited to test a refined resource package, including 2 rural and 2 urban primary care clinics in the southeastern and northeastern US, respectively. Multidisciplinary teams at each site (roles=medical management, behavioral counseling, & community referrals) were provided with a resource package that included various online training modules and clinical and patient education resources, along with regular opportunities for technical assistance and peer collaboration during structured QI activities. During 2 consecutive 6-month phases of QI, teams engaged in iterative Plan-Do-Study-Act cycles and submitted bi-monthly reports (i.e., improvement targets, successes, challenges, and, if applicable, chart reviews). At baseline and the end of each phase, teams also reported on the implementation stage of 28 key resources or monitoring systems to support HWC implementation. Stages included: 0=Deciding (considering utility), 1: Planning (actively strategizing); 2: Implementing (actively executing and adapting as needed), and 3: Sustaining (routinely executing without adaptation). Data were analyzed descriptively.

Results: One rural team was unable to fully engage in QI or complete project requirements due to ongoing challenges (e.g., loss of champion, ongoing staffing issues). The remaining 3 teams made significant progress in implementing HWC components and building capacity for key resources/monitoring systems (Figure), despite significant common barriers (e.g., staff availability/time/turnover). Capacity-building and implementation successes for each team were substantial and unique (Table). By the end of phase 2, teams had diversified their touchpoint/visit types (e.g., individual/group/telephone, in-person/telehealth, English/Spanish). Teams also reported considerable implementation progress/high implementation levels for tracking patient participation, monitoring no shows/sending reminders, coordinating HWC care, and supporting community partnerships, as well as setting patient goals and making community referrals during visits, but limited progress in monitoring HWC payments/costs.

Conclusion/Discussion: Overall results support the value of a resource package that included structured QI activities in supporting capacity-building and implementation for an evidence-based IHBLT intervention within primary care sites.