P0203 - Design and Baseline Provider Survey Results for a Novel Quality Improvement Initiative to Optimize Feeding, Prevent Obesity, and Support Overall Health for Children Under Two

Background: Obesity prevention guidelines for primary care providers (PCPs) are not available for children <2. However, >25% of children ages 2-5 have overweight or obesity, and studies increasingly identify the first 1000 days after conception as critical to obesity prevention and lifelong health. Results of recent national studies suggest that relevant nutrition and lifestyle behaviors for children <2 and pediatric practice focused on these same areas could be improved considerably.

Objectives: To describe the design of a novel quality improvement (QI) intervention to support PCPs in improving care relevant to early nutrition/obesity prevention during well visits for children <2 and to compare baseline PCP survey responses with known gaps in clinical care.

Design/

Methods: Optimize Infant and Toddler Feeding for Obesity Prevention is an all-virtual, 19-week, team-based collaborative, patterned after a successful QI project focused on obesity-related care in older children. Participating teams attend national webinars, hold local meetings, complete required educational modules, engage in Plan-Do-Study-Act cycles, and submit 3 cycles of clinical data with a 4th cycle submitted 6 months later. Key drivers/strategies were informed by national-level evidence and intended to address known gaps in care and facilitate a comprehensive approach to early growth, consistent with optimal child health (Figure 1). Supports include training, newly developed tools, and ongoing technical assistance. A national pilot was launched in late January 2020 with participation by 19 diverse practice teams. Due to the pandemic, it was paused in mid-March, with plans to resume in spring/summer. Apart from clinical measures, progress will be assessed through PCP reports of routine practice in pre/post surveys. Here, baseline survey responses (n=92; response rate= 88%) were examined descriptively, relative to responses from the 2017 AAP Periodic Survey of Fellows, to further inform the intervention.

Results/

Discussion: At baseline, a large majority of PCPs reported counseling women to breastfeed for the recommended duration of ≥12 months (91%). However, considerably fewer reported counseling women to exclusively breastfeed for 6 months (53%), consistent with a discrepancy observed nationally (89% versus 41%). Only 52% of PCPs reported counseling parents to delay complementary food introduction until the recommended age of 6 months, slightly higher than the national value of 45%. Consistent with national results, a large majority of participants reported routinely counseling on topics related to child dietary intake (e.g., fruits and vegetables; sugar-sweetened beverages) (Figure 2). However, fewer reported counseling on topics concerning parenting/home strategies to support healthy eating, with a few favorable exceptions (e.g., responsive feeding; family meals).

Conclusion: Although participating PCPs may represent “early adopters,” baseline survey responses are consistent with known gaps in care from national data. This points to the value of Periodic Survey data in informing local and regional QI design. Additional results are anticipated by September 2020.