249714 UCLA Fit for Residents Project: Results from the AAP and AAFP Collaborative project to train residents based on the chronic care model in the prevention and management of pediatric obesity

Tuesday, November 1, 2011: 5:30 PM

Alma Guerrero, MD, MPH , UCLA Center for Healthier Children, Families and Communities, Mattel Children's Hospital, UCLA, Los Angeles, CA
Debra Lotstein, MD, MPH , UCLA Schools Of Medicine and Public Health, Mattel Children's Hospital, UCLA, Los Angeles, CA
Heidi Fischer, MPH , Biostatistics, UCLA School of Public Health, Los Angeles, CA
Margaret Whitley , Community Health Sciences, UCLA School of Public Health, Los Angeles, CA
Sandra Portocarrero , Pediatrics, Mattel Children's Hospital, UCLA, Los Angeles
Wendelin Slusser, MD, MS , UCLA Schools of Medicine and Public Health, Mattel Children's Hospital, UCLA, Los Angeles, CA
Background: Primary care physicians are often limited in their skills to prevent and manage pediatric obesity due to minimal education in nutrition and physical activity promotion. Guided by the chronic care model to address this training gap, UCLA in collaboration with the American Academy of Pediatrics (AAP) Chapter 2 and the national AAP and the American Academy of Family Physicians (AAFP), developed and piloted a childhood overweight prevention and management curriculum in residency training programs. Implementation of the pilot study was based on the successful residency education change model developed by the AAP breastfeeding work group.

Objective: To evaluate a childhood overweight prevention and management curriculum, Fit for Residents, aimed to prepare the future physician workforce to have an expanded role in prevention and management of pediatric obesity.

Design/Methods A multidisciplinary group of national experts developed a curriculum guide based on the chronic care model to prevent and manage pediatric obesity. Through a competitive proposal process, five pediatric or family physician residency programs and comparison sites were chosen in California to participate in piloting of the curriculum. Key faculty from the pilot residency programs received training and on-going technical assistance over the course of the pilot year that started July 2009 and ended June 2010. Quality improvement strategies guided the clinical changes of the curriculum. The knowledge and advocacy objectives of the curriculum were met using online, didactic, and experiential learning.

Questionnaires measuring the residents knowledge, attitude, and practices were administered at baseline and end of the project year at both control and intervention residency program sites. Data from monthly continuity chart reviews (20/month/site) were collected from all residency program sites and regular feedback was provided to the pilot programs.

Results Resident knowledge, attitudes and practices significantly increased at the end of the one-year pilot program (p-value <.01). Resident knowledge scores were significantly higher in the intervention versus the comparison programs at follow-up (p-value <.05), and there was no significant change in the comparison sites. Chart review data over the course of the study year for the intervention sites, suggest upward trends in percent of charts with BMI calculated, BMI classified, and nutrition and physical activity topics assessed. Conclusions Focusing on the prevention and management of pediatric obesity in residency education utilizing the chronic care model as the framework can significantly change pediatric and family physician resident knowledge, attitudes and practices.

Learning Areas:
Administer health education strategies, interventions and programs
Chronic disease management and prevention
Clinical medicine applied in public health
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Public health or related research

Learning Objectives:
1. Identify how the prevention and treatment of childhood obesity can effectively be addressed using the Chronic Care Model. 2. Describe the Fit for Residents project and how it is helping to prevent and treat childhood obesity.

Keywords: Obesity, Child Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Dr. Guerrero is an Assistant Clinical Professor in the Department of Pediatrics at UCLA. She received her medical degree in 1999 from the David Geffen School of medicine at UCLA and completed a pediatric residency training program at UCLA through the Community Health Advocacy and Training track. Following her clinical training Dr. Guerrero completed a Maternal and Child Health Fellowship at UCLA and concurrently received a Masters in Public Health in 2008 through the UCLA School of Public Health. Dr. Guerrero’s research has focused on examining parental perceptions of childhood obesity, family experiences with receiving child developmental assessments in primary care, and pediatric racial/ethnic disparities in receiving family-centered care. Guerrero’s work also includes a primary intervention through the Early Developmental Screening and Intervention (EDSI) to improve child development education among low-income largely Latina mothers who participate in the Los Angeles County WIC programs. Dr. Guerrero practices general pediatrics working with vulnerable populations in the Los Angeles area who have high unmet medical and psychosocial needs. Dr. Guerrero is also involved with medical education at UCLA and is a core faculty member for the Community Health and Advocacy Training Program for pediatric residents at UCLA.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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