Key Results of the Infant and Toddler Feeding for Obesity Prevention Pilot Project for Participating Fqhcs and Non-fqhcs

Purpose/Objectives: Studies have shown that pediatric practice supporting healthy lifestyles and healthy weight for children under 2 can be improved considerably, suggesting a role for targeted quality improvement (QI) projects. Due to disparities in outcomes for low-income groups, it is important to engage practices caring for underserved populations, such as Federally Qualified Health Centers/Look-Alikes (FQHCs), although improving care may be particularly challenging in such settings. Projects must also ensure that care remains comprehensive and improvements do not interfere with other aspects of care. Optimize Infant and Toddler Feeding for Obesity Prevention is a 19-week, virtual, team-based, QI collaborative, designed to help providers comprehensively support healthy lifestyle/weight for children under 2 years during well visits. Participation by FQHCs was specifically solicited during the pilot. The objective of this analysis was to examine key results for FQHCs and Non-FQHCs.

Design/Methods: The project began in January 2020 but was paused in mid-March for 10 weeks, due to the COVID-19 pandemic. Sixteen teams completed the pilot, including 9 FQHCs and 7 Non-FQHCs. During the collaborative, teams submitted 3 cycles of data (T1-3), based on 20 randomly selected charts, which were used to calculate 10 clinical measures. Teams also submitted a 4th monitoring data cycle 3-1/2 months after the collaborative. Within post-collaborative surveys, providers answered 6 Likert-type questions about the overall impact of participation on care and satisfaction. An additional question concerned the extent to which the pandemic had interfered with practice improvements. Changes in aggregate clinical measures were analyzed using Fisher’s exact test (p <.025); other analyses were descriptive.

Results: Several baseline clinical measures were lower in FQHCs but showed early and consistent improvement (Table 1). By T3, 6 measures improved for Non-FQHCs (assessments for pre-/perinatal risks, weight-for-length, diet/nutrition, social determinants of health (SDOH); counseling for diet/nutrition, parenting/home environment), and 5 improved for FQHCs (assessments for pre-/perinatal risks, weight-for-length, patient/family concerns, parenting/home environment, SDOH). At T4, improvements were sustained for Non-FQHCs. For FQHCs, only minor shifts occurred in 2 high measures (patient/family concerns assessments became non-significant; diet/nutrition counseling became significant.). Results of summed measures showed an increase in total assessments and counseled topics per visit for both Non-FQHCs and FQHCs over time, with considerable catch-up by FQHCs (Figure 1). Within surveys, 54% and 70% of Non-FQHC and FQHC providers, respectively, reported at least a moderate impact of the pandemic on improvement efforts, possibly also accounting for somewhat low survey response rates.(Non-FQHCs=61%; FQHCs=72%%). Nevertheless, providers overwhelmingly did not perceive interference on other aspects of care, and 79% and 70% at Non-FQHCs and FQHCs, respectively, reported moderate to high overall levels of satisfaction with participation.

Conclusion/Discussion: Clinical and survey measures support that both FQHCs and Non-FQHCs benefitted from participation in the pilot, despite significant ongoing challenges due to the pandemic.