Accuracy of Electronic Health Record Phenotypes to Detect Recognition of Hypertension in Pediatric Primary Care.

Objective: To evaluate the accuracy of extractable electronic health record (EHR) data to define clinician recognition of hypertension in pediatric primary care.

Methods: We used EHR data to perform a cross-sectional study of children aged 3-18 years at well-visits in Connecticut from 2018-2023 (n=50,290) that had either: (1) incident hypertension (hypertensive BP at the well-visit and ≥2 prior hypertensive BPs without prior diagnosis of hypertension); or (2) isolated hypertensive BP at the well-visit without necessarily having prior hypertensive BPs. We tested the accuracy of EHR phenotypes to detect recognition of incident hypertension or hypertensive BP using structured elements, including diagnosis codes, problem list entries, number of BP measurements, orders, and follow-up information.

Perspectives on Medical School Admission for Black Students Among Premedical Advisers at Historically Black Colleges and Universities.

Importance: There remains a lack of representation of Black physicians in the physician workforce despite decades of national efforts to increase diversity. Historically Black Colleges and Universities (HBCUs) contribute to increasing representation in the workforce in the US. There is limited literature exploring the experiences of HBCU premedical students navigating the journey to medical school.

Overview of the Treatment of Pediatric Obesity and the 2023 Clinical Practice Guidelines.

In 2023, the American Academy of Pediatrics (AAP) published its first clinical practice guideline (CPG) for the treatment of obesity. The CPG is organized by key action statements (KAS) and consensus recommendations that address screening, diagnosis and evaluatin of children and adolescents with obesity, assessment of comorbidities and evidence-based treatment options. The evidence base for each KAS and recommendation is detailed alongside care recommendations.

Implementation and evaluation of an electronic consult program at a large academic health system.

Background: Although the benefits of eConsults in increasing access and lowering unnecessary utilization have been well described, the development of a successful program can be challenging.

Objective: We sought to share the experiences of a large academic health system in implementing and evaluating a high-volume electronic consultation (eConsult) program across 34 adult and pediatric medical and surgical specialties.

Methods: Using a multi-method approach, we collected qualitative and quantitative data on operational and process outcomes to describe adoption of eConsults, and survey data to capture satisfaction and experience among referring and specialist clinicians.

External Validation of an Electronic Phenotyping Algorithm Detecting Attention to High Body Mass Index in Pediatric Primary Care.

Objectives:  The lack of feasible and meaningful measures of clinicians' behavior hinders efforts to assess and improve obesity management in pediatric primary care. In this study, we examined the external validity of a novel algorithm, previously validated in a single geographic region, using structured electronic health record (EHR) data to identify phenotypes of clinicians' attention to elevated body mass index (BMI) and weight-related comorbidities.

Methods:  We extracted structured EHR data for 300 randomly selected 6- to 12-year-old children with elevated BMI seen for well-child visits from June 2018 to May 2019 at pediatric primary care practices affiliated with Yale.

Improving access to first-line treatment for pediatric obesity: Lessons from the dissemination of SmartMoves.

Objective: The increasing prevalence of and inequities in childhood obesity demand improved access to effective treatment. The SmartMoves curriculum used in Bright Bodies, a proven-effective, intensive health behavior and lifestyle treatment (IHBLT), was disseminated to ≥30 US sites from 2003 to 2018. We aimed to identify barriers to and facilitators of IHBLT implementation/sustainment.

Cost-effectiveness of a primary care-based Healthy Weight Clinic compared with usual care.

Objective: The objective of this study was to project the cost-effectiveness of implementing the Healthy Weight Clinic (HWC), a primary care-based intervention for 6- to 12-year-old children with overweight or obesity, at federally qualified health centers (FQHCs) nationally.

Methods: We estimated intervention costs from a health care sector and societal perspective and used BMI change estimates from the HWC trial. Our microsimulation of national HWC implementation among all FQHCs from 2023 to 2032 estimated cost per child and per quality-adjusted life year (QALY) gained and projected impact on obesity prevalence by race and ethnicity.

Barriers to and facilitators of improving physical activity and nutrition behaviors during chemotherapy for breast cancer: a sequential mixed methods study.

Purpose: Use qualitative and quantitative methods to explore factors influencing the adoption of guideline-based physical activity (PA) and dietary recommendations among participants enrolled in a lifestyle intervention during and after chemotherapy for breast cancer.

Methods: Among women with stage I-III breast cancer who participated in the intervention arm of the Lifestyle, Exercise, and Nutrition early after diagnosis (LEANer) trial, we used stratified, purposeful sampling to interview women who met both, one, or neither intervention goal after the 1-year intervention: (1) 150 min/week moderate-to-vigorous intensity exercise via a self-reported PA questionnaire and (2) improved self-reported diet quality measured by the Healthy Eating Index-2015. Semi-structured interviews were audio-recorded, transcribed verbatim, and analyzed using thematic content analysis.

Quantifying the Association between Pump Use and Breastfeeding Duration.

Objective: To quantify the extent to which pump use is associated with breastfeeding duration.

Study Design: We conducted a cross-sectional analysis of weighted data from the Centers for Disease Control and Prevention Pregnancy Risk Assessment Monitoring System from Maine, Michigan, New Mexico, and Utah between 2016 and 2021. Included respondents had a live-born infant at survey completion, initiated breastfeeding, and had nonmissing data for reported pump use and breastfeeding duration.

Better Guidelines and Policies: AAP's Partnership for Policy Implementation.

Objectives: In 2005, the American Academy of Pediatrics founded the Partnership for Policy Implementation (PPI). The PPI has collaborated with authors to improve the quality of clinical guidelines, technical reports, and policies that standardize care delivery, improve care quality and patient outcomes, and reduce variation and costs.

Methods: In this article, we describe how the PPI trained informaticians apply a variety of tools and techniques to these guidance documents, eliminating ambiguity in clinical recommendations and allowing guideline recommendations to be implemented by practicing clinicians and electronic health record (EHR) developers more easily.

User-Centered Framework for Implementation of Technology (UFIT): Development of an Integrated Framework for Designing Clinical Decision Support Tools Packaged With Tailored Implementation Strategies.

Background: Electronic health record-based clinical decision support (CDS) tools can facilitate the adoption of evidence into practice. Yet, the impact of CDS beyond single-site implementation is often limited by dissemination and implementation barriers related to site- and user-specific variation in workflows and behaviors. The translation of evidence-based CDS from initial development to implementation in heterogeneous environments requires a framework that assures careful balancing of fidelity to core functional elements with adaptations to ensure compatibility with new contexts.

High Blood Pressure in Children Aged 3 to 12 Years Old With Overweight or Obesity.

(1) To describe the prevalence of high blood pressure (BP) and the association with BMI in young children with overweight/obesity; (2) to evaluate the accuracy of a single high BP to diagnose sustained hypertension over three visits. We used pre-intervention data from the Improving Pediatric Obesity Practice Using Prompts (iPOP-UP) trial. We included children aged 3-12 years with BMI ≥85th percentile at well-visits in 2019-2021 at 84 primary care practices in 3 US health systems in the Northeast, Midwest, and South.

Improving lifestyle behaviors during chemotherapy for breast cancer: The Lifestyle, Exercise, and Nutrition Early After Diagnosis (LEANer) Trial.

Background: Little is known about improving physical activity (PA) and diet during and after chemotherapy for breast cancer. This secondary analysis examines changes in PA and diet quality during a yearlong intervention for patients with breast cancer undergoing chemotherapy and evaluates factors associated with these changes.

Methods: Newly diagnosed patients with breast cancer (N = 173) undergoing chemotherapy were randomized to a year-long nutrition and exercise intervention (n = 87) or usual care (UC, n = 86).

The Role of the Pediatrician in the Promotion of Healthy, Active Living.

Few children and adolescents meet federal nutrition or physical activity recommendations, and many experience poor or inadequate sleep and negative health effects from screen use and social media. These lifestyle factors exacerbate physical and mental health risks for children and adolescents. This clinical report provides guidance to help pediatricians address the nutritional, physical activity, sleep, media and screen use, and social-emotional factors that affect child and adolescent health and wellness.

A Narrative Review of Public Health Interventions for Childhood Obesity.

Purpose Of Review: Public health interventions that intervene on macrolevel systems hold the promise of reducing childhood obesity at the population level through prevention. The purpose of this review is to highlight some of the recent and best scientific evidence related to public health interventions for the prevention of childhood obesity. We provide a narrative review of scientific evidence for six categories of public health interventions and their impact on childhood obesity: federal nutrition assistance programs, programs implemented in early care and education centers, interventions to support healthy nutrition and physical activity in schools, community-based programs and policies, labeling policies and marketing to children, and taxes on sugar sweetened beverages (SSB).

Post-diagnosis weight trajectories and mortality among women with breast cancer.

Weight gain after breast cancer diagnosis is associated with adverse health outcomes. Yet, few studies have characterized post-diagnosis weight change in the modern treatment era or populations most at risk for weight changes. Among women diagnosed with stages I-III breast cancer in the Smilow Care Network (2013-2019; N = 5441), we abstracted demographic and clinical characteristics from electronic health records and survival data from tumor registries.

Randomized Trial Evaluating a Self-Guided Lifestyle Intervention Delivered via Evidence-Based Materials versus a Waitlist Group on Changes in Body Weight, Diet Quality, Physical Activity, and Quality of Life among Breast Cancer Survivors.

Lifestyle interventions for breast cancer survivors have proved effective at stimulating positive behavior change and promoting healthy weight loss, although integrating these programs into clinical practice is challenging. We evaluated the effect of a 6-month, unsupervised, self-guided, lifestyle intervention using printed materials and online videos vs. waitlist group on body weight for breast cancer survivors.

Exploring the determinants of successful implementation of a preventive mental health and wellness intervention for Afghan refugee families: a qualitative analysis.

Many refugee children experience trauma in early childhood. Effective, tailored interventions are needed to improve refugee children's access to preventive mental health. We interviewed refugee-serving stakeholders and parents participating in an evidence-based preventive mental health and wellness intervention adapted for Afghan refugee children and families who may have experienced trauma.

Clinicians' Perspectives on Equitable Health Care Delivery in Group Well-Child Care.

Objective: To explore clinicians' perspectives about the impact of group well-child care (GWCC) on equitable health care delivery.

Methods: In this qualitative study, we conducted semistructured interviews with clinicians engaged in GWCC recruited via purposive and snowball sampling. We first conducted a deductive content analysis using constructs from Donabedian's framework for health care quality (structure, process, and outcomes) followed by inductive thematic analysis within these constructs.

Cost-Effectiveness and Long-Term Savings of the Bright Bodies Intervention for Childhood Obesity.

Objectives: To estimate the cost and cost-effectiveness of Bright Bodies, a high-intensity, family-based intervention that has been demonstrated to improve body mass index (BMI) among children with obesity in a randomized controlled trial.

Methods: We developed a microsimulation model to project 10-year BMI trajectories of 8 to 16-year-old children with obesity, using data from the National Longitudinal Surveys and Centers for Disease Control and Prevention growth charts, and we validated the model using data from the Bright Bodies trial and a follow-up study. We used the trial data to estimate the average reduction in BMI per person-year over 10 years and the incremental costs of Bright Bodies, compared with the traditional clinical weight management (control), from a health system's perspective in 2020 US dollars.