Clinical Initiatives Manager, Institute for Healthy Childhood Weight American Academy of Pediatrics Itasca, Illinois, United States
Background: Care for children with obesity is highly variable and experience based. Clinical practice guidelines (CPG) can improve care and outcomes but are underutilized. Integration of decision support within workflows can bridge the gap between evidence-based guidelines and frontline utilization. To date, this translation has been fraught with barriers such as high cost and design issues. Objective: To develop and implement a sharable and interoperable tool for rapidly integrating pediatric obesity treatment CPG recommendations into primary care clinical workflows. Design/Methods: The Institute for Healthy Childhood Weight partnered with Curbside Health, Inc. to translate the 2023 American Academy of Pediatrics CPG for the Evaluation and Treatment of Children and Adolescents with Obesity from >100-pages into an actionable, dynamic pathway. The pathway is available through a simple weblink (no data), a specific link (minimal, deidentified data), or full electronic health record (EHR) integration using an application programming interface and Fast Healthcare Interoperability Resources. To iteratively refine the design of the user interface and identify potential barriers to implementation, we conducted key informant interviews and usability testing with primary care providers and subject matter experts using a semi-structured interview guide and a content analysis using detailed field notes from interviews. Lastly, we collected utilization data from pilot implementation sites to identify highly utilized components of the pathway. Results: Of 10 interviews completed to date with participants across the U.S., most were with large hospitals/clinics, often associated with academic institutions, and using multiple EHR vendors. Barriers to implementation included a lack of clinically relevant and pediatric specific resources with a need for web-based point-of-care tools that translate the guidance into actionable steps within primary care. Participants reacted positively to the Obesity CPG Pathway (Figure 1) while noting opportunities to improve usefulness and usability through modifications such as inclusion of specialty referrals, one-click additions to problem list, comorbidity integration, and more lab/vital results in the dashboard. Among 35 clinicians at 11 pilot sites, highly utilized components of the pathway include extended growth charts, lab values, related CPG content and the share functionality (Figure 2).
Conclusion(s): Utilization of the pathway at the point of care may address known practice and provider-level barriers to guideline-concordant care.
