The Families Improving Health Together (FIT) Program: Initial evaluation of retention and research in a multispecialty clinic for children with obesity.

BACKGROUND: Obesity affects ∼17% of US children, with parallel increases in multiple comorbidities, especially among African-, Asian-, Hispanic-, and Native-Americans. Barriers to patient retention in pediatric obesity programs include lack of centralized care, and frequent subspecialty MD visits which conflict with patient school attendance and parental work attendance as well as with support service utilization. Lack of integration of multispecialty clinical care with interdisciplinary research is a major barrier to fuller exploration of the treatment, prevention, and understanding of obesity in childhood. OBJECTIVE: To test the hypothesis, a novel multispecialty/interdisciplinary clinical and research infrastructure with strong emphasis on a primary obesity care physician for children with early-onset (<9 years) obesity (Families Improving health Together [FIT]) could promote lower patient attrition (primary goal) and foster productive research in pediatric obesity (secondary goal). RESULTS: Data support the hypotheses. Over 15 months, FIT reported a >90% participant retention (p < 0.001 vs. expected rate based on other studies of similar programs). Though 90% of children had at least one adiposity-related comorbidity and 70% had at least two, there was no need for additional subspecialist visits with cardiologists, endocrinologists, gastroenterologists, or molecular geneticists. Three abstracts were presented at national meetings, and two manuscripts were published all with junior faculty as primary authors. CONCLUSION: This pilot study suggests that an integrated multispecialty/interdisciplinary approach to children with obesity improves patient retention and can be integrated successfully with research.

Social Determinants of Health and COVID-19 Among Patients in New York City.

Background: Covid-19 testing and disease outcomes according to demographic and neighborhood characteristics must be understood. Methods: Using aggregate administrative data from a multi-site academic healthcare system in New York from March 1 - May 14, 2020, we examined patient demographic and neighborhood characteristics according to Covid-19 testing and disease outcomes. Results: Among the 23,918 patients, higher proportions of those over 65 years old, male sex, Hispanic ethnicity, Medicare, or Medicaid insurance had positive tests, were hospitalized, or died than those with younger age, non-Hispanic ethnicity, or private insurance. Patients living in census tracts with more non-White individuals, Hispanic individuals, individuals in poverty, or housing crowding had higher proportions of Covid-19 positive tests, hospitalizations, and deaths than counterparts. Discussion: Variation exists in Covid-19 testing and disease outcomes according to patient and neighborhood characteristics. There is a need to monitor Covid-19 testing access and disease outcomes and resolve racist policies and practices.