QI Study of a Practice Facilitator's Impact in Working With Clinics on Improving Dental, Lead & Obesity Measures for Children

NCT01739166 | Completed

• 1 other identifier: 10-10-07
• Study Type: interventional
• Target: 30
• Locations: 1 country
• Sites: 1

Brief Summary

Funded by the Ohio Department of Job and Family Services - Medicaid Technical Assistance and Policy Program (MEDTAPP), the "Child Health Excellence Center - a University-Practice-Public Partnership" (CHEC-UPPP) focuses on improving the health of Ohio's children in 3 target areas: 1) prevention of dental decay; 2) detection and management of overweight and obesity; and 3) lead screening. These topics represent critical public health issues for Ohio's children. The study is based on strong evidence that interventions are needed to improve practice in the target areas and that achieving these goals represents fundamental improvements in child health care that would reduce morbidity and costs. The approach for the study involves a trained Practice Facilitator (PF) working with multiple pediatric and family medicine practices to create change tailored to individual practice preferences and methods of operation. Our overall hypothesis is that a university-community consortium, utilizing evidence-based methods (involving education plus a facilitated, practice-tailored approach) will increase the rates of targeted services in primary care practices.

Conditions

Lead Poisoning; Obesity; Dental Decay

Keywords

Health Services Research; Quality Assurance

Outcome Measures

Primary Outcomes (3)

• Lead screening for at-risk 12 and 24 month olds

  Assessing the rate of lead screening for eligible (i.e., at risk) 12 and 24 month old children is our primary outcome. This is assessed by chart review in the medical record for the index visit.

  At baseline, every 2 months during the 6 month Intervention Phase, and after the 2 month Follow-up Phase

• Identification of BMI percentile and weight diagnosis catergory in 2-17 year olds

  Assessing the rate of recorded BMI and 2) and rate of accurate recorded weight diagnosis category (underweight \< 5th percentile; healthy weight 5th percentile -\<85th percentile; overweight 85th percentile - \<95th percentile; or obese \> 95th percentile) for children 2-17 years of age is our primary outcome. This is assessed by chart review in the medical record for the index visit.

  At baseline, every 2 months during the 6 month Intervention Phase, and after the 2 month Follow-up Phase

• Application of dental fluoride varnish for 12-36 month olds

  Assessing the rate of dental fluoride varnish application for eligible children 12-36 months of age is our primary outcome. This is assessed by chart review in the medical record for the index visit or within the preceding 6 months.

  At baseline, every 2 months during the 6 month Intervention Phase, and after the 2 month Follow-up Phase

Secondary Outcomes (3)

• Rates of elevated lead levels and appropriate follow-up for 12 and 24 months lead screenings

  At baseline, every 2 months during the 6 month Intervention and after the 2 month Follow-up Phase

• Rates of appropriate counseling for nutrition & activity and appropriate screening for co-morbidities

  At baseline, every 2 months during the 6 month Intervention Phase, and after the 2 month Follow-up Phase

• Rates of oral screening and referral to a dentist for 12-36 month olds

  At baseline, every 2 months during the 6 month Intervention Phase, and after the 2 month Follow-up Phase

Study Arms (2)

Practice-tailored intervention - Early/Phase 1

EXPERIMENTAL

During the 6 month Intervention Phase the Practice Facilitator works with each practice to create changes that are tailored to their individual preferences and methods of operation. Sites randomized to Early/Phase 1 start their 6 month intervention immediately after randomization.

Other: Practice-tailored intervention to increase rates of targeted services

Practice-tailored intervention - Late/Phase 2

EXPERIMENTAL

The Phase 2 group will start the practice-tailored intervention with the study facilitator 4 months post-randomization and continue through post-randomization month 10.

Other: Practice-tailored intervention to increase rates of targeted services

Interventions

Practice-tailored intervention to increase rates of targeted services OTHER

Over a 6 month period, the Practice Facilitator (PF), offers individualized suggestions, strategies and tools for streamlining processes and incorporating new ideas into the flow of a practice's work day to increase their rates of delivery of the 3 targeted services of lead screening, obesity detection and dental decay prevention. During the intervention visits the PF reviews a small number of recent well-visit charts. This allows for rapid feedback to a practice on their progress as they work toward reaching outcome measures. It also provides 'real time' feedback regarding the degree to which suggested interventions are working, allowing the PF to change the approach as needed.

Practice-tailored intervention - Early/Phase 1; Practice-tailored intervention - Late/Phase 2

Eligibility Criteria

• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Practice site has 20% or more Medicaid patient population
• Practice is located in Northeast Ohio

You may not qualify if:

• Practice has less than 20% Medicaid patient population
• Practice is out of the targeted area

Sponsors & Collaborators

• University Hospitals Cleveland Medical Center: lead
• Ohio Department of Job and Family Services: collaborator

Study Sites (1)

University Hospital Case Medical Center

Cleveland, Ohio, 44106, United States

Location

Related Publications (1)

• Meropol SB, Schiltz NK, Sattar A, Stange KC, Nevar AH, Davey C, Ferretti GA, Howell DE, Strosaker R, Vavrek P, Bader S, Ruhe MC, Cuttler L. Practice-tailored facilitation to improve pediatric preventive care delivery: a randomized trial. Pediatrics. 2014 Jun;133(6):e1664-75. doi: 10.1542/peds.2013-1578. Epub 2014 May 5.

  PMID: 24799539 DERIVED

MeSH Terms

Conditions

Lead Poisoning; Obesity; Dental Caries

Condition Hierarchy (Ancestors)

Heavy Metal Poisoning; Poisoning; Chemically-Induced Disorders; Overweight; Overnutrition; Nutrition Disorders; Nutritional and Metabolic Diseases; Body Weight; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Tooth Demineralization; Tooth Diseases; Stomatognathic Diseases

Study Officials

• Leona Cuttler, M.D.

  University Hospitals Cleveland Medical Center

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Intervention Model: CROSSOVER
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: November 27, 2012
• First Posted: December 3, 2012
• Study Start: October 1, 2010
• Primary Completion: November 1, 2012
• Study Completion: December 1, 2012
• Last Updated: December 3, 2014

Record last verified: 2014-12

Locations

US (1)