1. FIGURE 1. CLINICAL PATHWAY MODEL PROGRAM FACILITATORS AND BARRIERS
IMPROVING CLINICAL PATHWAYS TO MANAGE AND PREVENT OBESITY
Jennifer Torres, MSSW, MPH, PhD (c)1,4; Lisa Arangua, MPP1; Tony Kuo, MD, MSHS1-3
1Los Angeles County Department of Public Health, Division of Chronic Disease and Injury Prevention; 2David Geffen School of Medicine at UCLA; 3UCLA Jonathan and Karin Fielding School of Public Health; 4Columbia University
The Los Angles County Department of Public Health(LACDPH) is serving as a conduit to encourage the broad implementation of pediatric obesity strategies within safety net clinic systems. To date, some of the facilitators to implementation have been:
Understanding clinic staff capacity
Understanding clinic readiness to change
Securing a clinic champion
Facilitating community linkages
Challenges to project implementation include:
Clinic buy-in
Lack of time to conduct intervention during primary care well-child visits
By facilitating the creation of usual care protocols at safety net clinics, LAC DPH has the opportunity to aid in the development of a team-based approach to care and advance efforts towards PCMH certification.
FIGURE 1. CLINICAL PATHWAY MODEL
PROGRAM FACILITATORS AND BARRIERS
OVERVIEW
The epidemic of obesity is associated with significant morbidity and mortality, related social function, physical function, physical health and mental health.  Significant health disparities exist, as the greatest burden of obesity and the related disease of diabetes lies in low-income communities of color.  Obesity screening and management supports three of the Healthy People 2020 Leading Health Indicators:  (1)attainment of healthy behaviors that help prevent obesity; (2) access to evidence-based clinical preventive services; and (3) preventing chronic disease.
To address the Healthy People 2020 Indicators the Los Angeles County Department of Public Health (LAC DPH) has designed a clinical quality improvement (CQI) project to assist clinics with their quality improvement efforts. The primary program objective of this initiative is to encourage the systematic implementation of identification, documentation and tracking of BMI percentile for overweight and obese individuals in primary care safety-net clinic settings. A secondary objective is to encourage the implementation of a clinical pathway (CPW) for the evaluation and management of obesity in primary care safety-net clinic systems in the region.
The Los Angles County Department of Public Health is serving as a conduit to encourage the broad implementation of pediatric obesity strategies within safety net clinic systems.
To date, some of the facilitators to implementation have been:
Understanding clinic staff capacity
Understanding clinic readiness to change
Securing a clinic champion
Facilitating community linkages
Combining intervention with current CQI efforts (i.e., PCMH certification, meaningful use).
Challenges to project implementation include:
Clinic buy-in
Staff turn over
Lack of time to conduct intervention during primary care well-child visits
Lack of funding for implementation
Issues with establishing a bi-directional referral with community-based partners.
The Los Angeles County Department of Public Health has offered primary care safety-net clinics assistance in establishing formal obesity screening and management protocols and tools. The goal of the intervention is to: (1) provide participating clinics with the tools to routinely screen and track BMI percentile, (2) provide technical support for integrating obesity counseling as part of anticipatory guidance, (3) provide providers with resources to help counsel and set goals with individuals regarding nutrition and physical activity, 4) facilitate use of the Plan Do Study Act (PDSA) model to establish effective implementation of this protocol and tools, and 5) produce revised clinical pathways and tools based on PDSA results.
STUDY DESIGN
CONCLUSIONS
By facilitating the creation of a clinical pathway model at safety net clinics, LAC DPH has the opportunity to aid in the development of a team-based approach to care and advance efforts towards PCMH certification.
Early results from the Clinical Pathways model intervention suggest that the multi-level team approach is a promising strategy for early detection and management of childhood obesity, but are attenuated by implementation barriers. These barriers, however, could be mitigated by forthcoming health system changes that support and reimburse for team care under the Patient Protection and Affordable Care Act.
Participating safety-net clinics have improved obesity screening and management and learned how to perform CQI, a skill that can be applied to other clinical topics. Tools to facilitate each CQI step were developed, challenges were identified and addressed, and research/evaluation needs were identified.
RESULTS
Presenter Contact Information
Made possible with funding from First 5 LA through Los Angeles County Department of Public Health