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HEALTH-COP Obesity Prevention

Summary 
  • Need: Many physicians want to help rural children who are overweight or obese develop healthy lifestyles, and these physicians would benefit from receiving training on specific ways to instruct, motivate, and manage the healthcare of these children.
  • Intervention: A virtual learning network called Healthy Eating Active Living TeleHealth Community of Practice (HEALTH-COP) was created to educate rural physicians and provide peer support.
  • Results: Studies showed an increase in health and wellness topics covered by physicians during children's clinic visits. This likely contributed to healthier eating habits and more active lifestyles that were found when these children were reassessed 3 months later.

Evidence-level

Effective (About evidence-level criteria)

Description

The Healthy Eating Active Living TeleHealth Community of Practice (also called HEALTH-COP) was created to provide a virtual learning and quality improvement network as well as a peer support system for rural physicians working with children who are overweight or obese.

According to 2011-2012 HHS data, 35.5% of children in large rural areas and 38.2% of children in small rural areas were overweight or obese, compared to 30.1% of urban children. HEALTH-COP was implemented in 7 rural clinics across varying parts of California, including its northern and southern borders, to prevent obesity and improve the health status among rural Californian children.

Researchers studied the impact of HEALTH-COP in these rural healthcare settings through funding from the Agency for Healthcare Research and Quality (AHRQ). When the funding award ended, the program ended as well.

Services offered

Rural clinicians received training in various ways, such as videoconferencing. Training included ways to instruct, motivate, and manage the healthcare of children and families of children who are overweight or obese. Clinicians were also educated on:

  • Accurate assessment of patients' weight
  • Nutrition and fitness counseling
  • Clinic reorganization to deliver optimal care
  • Risk factor screening
  • Effective ways to discuss body weight with patients

Results

In a 2014 study, researchers examined adherence to various clinical practice recommendations performed by participating physicians, both before and after the implementation of HEALTH-COP. There were 7 primary care rural clinics and 288 children involved in the study. These children and their families went to these clinics for well-child care and participated over a 9-month timespan. Clinicians were scored based on their ability to effectively:

  • Document patient body mass index and other weight measures
  • Counsel patients and their families
  • Provide family-centered care

On a 0-5 scale, mean scores increased from 3.5 to 4.6 over the course of the study.

"Solving the Pediatric Obesity Problem in Rural Communities" also found that HEALTH-COP's influence led to a greater amount of topics covered with the family by the physician regarding their child's diet, screen time, and physical activity. Particular topics covered in greater depth included television, beverages high in sugar, family meals, and the importance of fruits and vegetables.

Follow-up measures found that these children also had healthier diets and more active lifestyles three months later, showing evidence of a positive behavioral impact, in part from improved counseling.

For more detailed information:

Shaikh, U., Romano, P., & Paterniti, D.A. (2015). Organizing for Quality Improvement in Health Care: An Example from Childhood Obesity Prevention. Quality Management in Health Care, 24(3), 121-128. Article Abstract

Shaikh, U., Nettiksimmons, J., Joseph, J.G., Tancredi, D., & Romano, P.S. (2014). Collaborative Practice Improvement for Childhood Obesity in Rural Clinics: the Healthy Eating Active Living Telehealth Community of Practice (HEALTH COP). American Journal of Medical Quality, 29(6), 467-475. Article Abstract

Shaikh, U., Nettiksimmons, J., Joseph, J.G., Tancredi, D.J., & Romano, P.S. (2012). Clinical Practice and Variation in Care for Childhood Obesity at Seven Clinics in California. Quality in Primary Care, 20(5), 335-344. Article Abstract

Barriers

UC Davis reported the following barriers:

  • Lacking resources
  • Getting families to return for follow-up visits
  • Finding time to comprehensively discuss obesity among clinicians' demanding schedules
  • Gaining enough managerial support, since this support often dictated the level of success of the clinic's program

Please read the UC Davis article for more information on challenges, tools, and strategies for enhancing obesity prevention in rural communities.

Replication

Adapting this program in other communities calls for the following components:

  • Experience of local clinicians in obesity prevention and management
  • Clinic-level resources
  • Community resources
  • Telecommunication capabilities of clinic
  • Academic site

Additionally, UC Davis has found four factors shown to help clinicians effectively address obesity:

  • Strong leadership support in the clinical setting
  • Prior experience of clinicians in pediatric obesity
  • Parental involvement in how programs were structured
  • Cross-communication among clinics

Additional resources:


Topics
Children and youth
Obesity and weight control
Physicians
Telehealth

States served
California

Date added
August 20, 2015

Date updated or reviewed
August 2, 2019


Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.