Sustainability of the Parenting at Mealtime and Playtime Learning Collaborative

1Irwin K, 2Zmuda E, 3Anzeljc S, 2Sternstein A
1OUHCOM, Columbus, OH, USA; 2Nationwide Children's Hospital, Columbus, OH, USA; 3Ohio AAP, Columbus, Ohio, USA

Introduction: Parenting at Mealtime and Playtime (PMP) is a Quality Improvement (QI) program with the goals of increasing obesity-related health risk assessments at well child visits (WCV) from birth to age 5 years and prevention of childhood obesity via early intervention. This QI project is a 6- to 7-month collaborative program between pediatric practices and the PMP team that occurs in “waves.”
In the first two waves of the study, the documentation rates of all risk assessment measures increased compared to baseline. The documentation rates at 6- and 12-months post-collaborative were higher than at baseline but were not sustained at the same rate as the last month of the program. As a result, the PMP team decided to further investigate the sustainability of this program within busy pediatric practices.
Methods: Four of the eight practices that participated in Wave 2 of PMP agreed to participate in this study. Three trained data collectors traveled to participating pediatric practices and performed retrospective chart audits on a randomly selected cohort of patients. Obesity health assessment QI measures were collected from every available WCV from birth to five years from September 2014 to May 2017. For any WCVs before September 2014, only anthropometric data was collected. The total number of charts reviewed in entirety was 1,048 (n=51 pre-intervention, n=487 intervention, and n=510 post-intervention).
Results: Documentation rates for the QI measures of weight status, nutrition, family history, goal follow-up, and activity all increased from pre-intervention to intervention and from intervention to post-intervention. BMI and goal setting increased from pre-intervention to intervention and were maintained from intervention to post-intervention. Analysis of anthropometric data evaluated trends in BMI classifications where a positive BMI Trend is defined as any change in BMI toward Healthy Weight (HW) or maintaining a HW. A negative BMI Trend is defined as any change in BMI away from HW (i.e. HW to obese). When comparing BMI Trends of 3 to5 year-olds pre-intervention to intervention, 72.8% of patients had a positive BMI Trend and 27.2% had a negative BMI trend. 75.5% of BMI Trends from pre-intervention to post-intervention were positive and 24.5% were negative. Overall comparisons between all time points yielded 74.7% with a positive BMI Trend and 25.3% with a negative BMI Trend.
Discussion: Overall, documentation of most obesity-related health risk assessments increased during the PMP collaborative and were either maintained or documented at a higher rate up to 2 years post-collaborative. However, only BMI and family history reached and maintained the desired 95% documentation rate during the project and post-collaborative. BMI Trends were positive in all time periods but were highest when comparing BMIs from pre- to post-intervention, which suggests more patients were moving toward the HW category in the 2 years after the PMP collaborative compared to prior to the collaborative. This BMI Trend data is at risk of bias due to not examining exact same patients in all categories.