Kenneth A LaBresh1, Adolfo J Ariza2, Suzanne Lazorick3, Robert D Furberg4, Lauren Whetstone5, Connie Hobbs4, Janet de Jesus6, Ilse G Salinas7, Randall H Bender4, Helen J Binns8. 1. RTI International Waltham, Massachusetts; klabresh@rti.org. 2. Pediatric Practice Research Group, Mary Ann & J. Milburn Smith Child Health Research Program, Stanley Manne Children's Research Institute, Chicago, Illinois; Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; 3. Brody School of Medicine, Departments of Pediatrics and Public Health, East Carolina University, Greenville North Carolina; 4. RTI International Waltham, Massachusetts; 5. Brody School of Medicine, Departments of Pediatrics and Public Health, East Carolina University, Greenville North Carolina; Public Health Institute, Research and Evaluation Section Nutrition Education and Obesity Prevention Branch, California Department of Public Health, Sacramento, California; and. 6. National Heart, Lung, and Blood Institute, Bethesda, Maryland. 7. Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; 8. Pediatric Practice Research Group, Mary Ann & J. Milburn Smith Child Health Research Program, Stanley Manne Children's Research Institute, Chicago, Illinois;
Abstract
BACKGROUND AND OBJECTIVES:Cardiovascular disease (CVD) and underlying atherosclerosis begin in childhood and are related to CVD risk factors. This study evaluates tools and strategies to enhance adoption of new CVD risk reduction guidelines for children. METHODS:Thirty-two practices, recruited and supported by 2 primary care research networks, were cluster randomized to a multifaceted controlled intervention. Practices were compared with guideline-based individual and composite measures for BMI, blood pressure (BP), and tobacco. Composite measures were constructed by summing the numerators and denominators of individual measures. Preintervention and postintervention measures were assessed by medical record review of children ages 3 to 11 years. Changes in measures (pre-post and intervention versus control) were compared. RESULTS: The intervention group BP composite improved by 29.5%, increasing from 49.7% to 79.2%, compared with the control group (49.5% to 49.6%; P < .001). Intervention group BP interpretation improved by 61.1% (from 0.2% to 61.3%), compared with the control group (0.4% to 0.6%; P < .001). The assessment of tobacco exposure or use for 5- to 11-year-olds in the intervention group improved by 30.3% (from 3.4% to 49.1%) versus the control group (0.6% to 21.4%) (P = .042). No significant change was seen in the BMI or tobacco composites measures. The overall composite of 9 measures improved by 13.4% (from 48.2% to 69.8%) for the intervention group versus the control group (47.4% to 55.2%) (P = .01). CONCLUSIONS: Significant improvement was demonstrated in the overall composite measure, the composite measure of BP, and tobacco assessment and advice for children aged 5 to 11 years.
RCT Entities:
BACKGROUND AND OBJECTIVES:Cardiovascular disease (CVD) and underlying atherosclerosis begin in childhood and are related to CVD risk factors. This study evaluates tools and strategies to enhance adoption of new CVD risk reduction guidelines for children. METHODS: Thirty-two practices, recruited and supported by 2 primary care research networks, were cluster randomized to a multifaceted controlled intervention. Practices were compared with guideline-based individual and composite measures for BMI, blood pressure (BP), and tobacco. Composite measures were constructed by summing the numerators and denominators of individual measures. Preintervention and postintervention measures were assessed by medical record review of children ages 3 to 11 years. Changes in measures (pre-post and intervention versus control) were compared. RESULTS: The intervention group BP composite improved by 29.5%, increasing from 49.7% to 79.2%, compared with the control group (49.5% to 49.6%; P < .001). Intervention group BP interpretation improved by 61.1% (from 0.2% to 61.3%), compared with the control group (0.4% to 0.6%; P < .001). The assessment of tobacco exposure or use for 5- to 11-year-olds in the intervention group improved by 30.3% (from 3.4% to 49.1%) versus the control group (0.6% to 21.4%) (P = .042). No significant change was seen in the BMI or tobacco composites measures. The overall composite of 9 measures improved by 13.4% (from 48.2% to 69.8%) for the intervention group versus the control group (47.4% to 55.2%) (P = .01). CONCLUSIONS: Significant improvement was demonstrated in the overall composite measure, the composite measure of BP, and tobacco assessment and advice for children aged 5 to 11 years.
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