The Childhood Obesity Data Initiative: A Case Study in Implementing Clinical-Community Infrastructure Enhancements to Support Health Services Research and Public Health.

CONTEXT: We describe a participatory framework that enhanced and implemented innovative changes to an existing distributed health data network (DHDN) infrastructure to support linkage across sectors and systems. Our processes and lessons learned provide a potential framework for other multidisciplinary infrastructure development projects that engage in a participatory decision-making process. PROGRAM: The Childhood Obesity Data Initiative (CODI) provides a potential framework for local and national stakeholders with public health, clinical, health services research, community intervention, and information technology expertise to collaboratively develop a DHDN infrastructure that enhances data capacity for patient-centered outcomes research and public health surveillance. CODI utilizes a participatory approach to guide decision making among clinical and community partners. IMPLEMENTATION: CODI's multidisciplinary group of public health and clinical scientists and information technology experts collectively defined key components of CODI's infrastructure and selected and enhanced existing tools and data models. We conducted a pilot implementation with 3 health care systems and 2 community partners in the greater Denver Metro Area during 2018-2020. EVALUATION: We developed an evaluation plan based primarily on the Good Evaluation Practice in Health Informatics guideline. An independent third party implemented the evaluation plan for the CODI development phase by conducting interviews to identify lessons learned from the participatory decision-making processes. DISCUSSION: We demonstrate the feasibility of rapid innovation based upon an iterative and collaborative process and existing infrastructure. Collaborative engagement of stakeholders early and iteratively was critical to ensure a common understanding of the research and project objectives, current state of technological capacity, intended use, and the desired future state of CODI architecture. Integration of community partners' data with clinical data may require the use of a trusted third party's infrastructure. Lessons learned from our process may help others develop or improve similar DHDNs.

A Review of Modifiable Risk Factors for Severe Obesity in Children Ages 5 and Under.

Early-onset severe obesity in childhood presents a significant clinical challenge signaling an urgent need for effective and sustainable interventions. A large body of literature examines overweight and obesity, but little focuses specifically on the risk factors for severe obesity in children ages 5 and younger. This narrative review identified modifiable risk factors associated with severe obesity in children ages 5 and younger: nutrition (consuming sugar sweetened beverages and fast food), activity (low frequency of outdoor play and excessive screen time), behaviors (lower satiety responsiveness, sleeping with a bottle, lack of bedtime rules, and short sleep duration), and socio-environmental risk factors (informal child care setting, history of obesity in the mother, and gestational diabetes). The lack of literature on this topic highlights the need for additional research on potentially modifiable risk factors for early-onset severe obesity.

Increasing patient attendance in a pediatric obesity clinic: a quality improvement project.

Research supports intensive lifestyle interventions (>25 contact hours/six months) to treat childhood obesity. Success requires retention in program. This quality improvement project's purpose was to increase attendance of follow-up patients in a childhood obesity clinic by 10%. A pretest posttest design was used. Three months of baseline data were collected, followed by 52 weeks of intervention data. Data were analyzed using descriptive statistics and Fisher's exact test. Follow-up patient attendance improved significantly from 69% to 81% (z=1.76, p=.039 (95% CI=0.2822, 1.0021)). Simple and inexpensive interventions can significantly increase attendance of obese children in follow-up.

Implementing a pediatric obesity care guideline in a freestanding children's hospital to improve child safety and hospital preparedness.

Medical and surgical care of children with severe obesity is complicated and requires recognition of the problem, appropriate equipment, and safe management. There is little literature describing patient, provider, and institutional needs for the severely obese pediatric patient. Nonetheless, the limited data suggest 3 broad categories of needs unique to this population: (a) airway management, (b) drug dosing and pharmacology, and (c) equipment and infrastructure. We describe an opportunity at the Children's Hospital Colorado to better prepare and optimize care for this patient population by creation of a Pediatric Obesity Care Guideline that focused on key areas of quality and safety.

Identification and treatment of obesity as a standard of care for all patients in children's hospitals.

Obese children and adolescents have unique needs for specialized medical equipment while hospitalized and might require special diets and physical activity options as part of their medical treatment. It is important that patients with a diagnosis of obesity be identified on admission so that appropriate equipment and resources can be provided. We examined what components a healthy hospital environment should include and sought to determine if children's hospitals provide a healthy hospital environment that offers these components. In addition, we sought to determine if children's hospitals have policies in place to identify children with obesity so that appropriate resources and services can be offered to treat that diagnosis. We surveyed National Association of Children's Hospitals and Related Institutions member hospitals via a Web-based questionnaire and found that the majority of them do not have policies in place to identify patients with obesity. We did find that the majority of hospitals reported innovative programs or services to provide a healthy hospital environment for their patients, visitors, and staff but acknowledged limitations in providing some services. Specifically, children's hospitals can and should improve on their identification and management of obese pediatric patients.