Abstract 13865: Improvement of Guideline Use in Young Hearts Strong Starts, a Cluster Randomized Trial of Cardiovascular Prevention in Pediatric Offices
Objective: To evaluate the impact of a multifaceted intervention for assessment, Interpretation and treatment of BMI, BP and tobacco exposure and use during routine well child visits, based on the NHLBI sponsored Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk in Children and Adolescents
Methods: Thirty-two pediatric or multispecialty office practices from two research networks were cluster randomized based on practice size, location and type. The intervention group of 16 practices received a multifaceted intervention consisting of guideline dissemination, academic detailing, a toolkit with a clinical decision support application, collaborative webinars for expert presentations and practice sharing, and e-mail list and office visit coaching, compared to guideline dissemination only in the control group. Adherence to measures derived from the guidelines in BMI, BP, and tobacco in children aged 3-11 years, were assessed by external chart review in 16 intervention practice and 16 control practices at baseline and following the one-year intervention.
Results: The primary outcome was a composite of BMI and BP recorded, interpreted, and recommended, tobacco exposure assessment and antismoking counseling. Significant improvement was seen in the intervention group composite (21.7% change compared to 8.3% in the control group) p=0.0099. The major areas of improvement in the intervention group were blood pressure interpreted (60.5 % vs. 0.2% control) p<0.0001 and tobacco counseling in age 5 - 11 (48.8% vs. 19.8% control) p=.04. No significant change was seen in BMI measures which were high at baseline.
Conclusion: Significant improvement was seen over one year in the adoption of CV prevention guidelines in clinical practices during well child visits using a multifaceted intervention, particularly in the interpretation of BP and in counseling about smoking compared with control practices.
- © 2013 by American Heart Association, Inc.