Funded Projects

Problem:

CHS's target population experiences a high rate of obesity. Statistics pulled from our database, indicates that 17% of CHS patients are considered overweight and 20% are considered obese, compared with 15.1% and 13.6% respectively of children statewide. Goals and Objectives Goal 1: To improve and/or reduce obesity-related comorbidities over time. Objective 1: By December 31, 2015, CHS will evaluate patients with obesity-related comorbidity to determine if they are exhibiting signs of improvement. Patients will be re-evaluated by December 31, 2017 to determine degrees of improvement. Objective 2: By December 31, 2014, 100% of patients with an obesity-related comorbidity will be referred to an appropriate specialist. The Patient Navigator will follow-up with patients to ensure they schedule and attend appointments for all referrals within 30 days. Objective 3: By December 31, 2014, 80% of overweight or obese patients with persistent asthma will be seen by a provider every 3 months for follow-up care, which will follow Colorado Clinic Guidelines including receiving an annual flu shot. Goal 2: To encourage the use of goal-setting by overweight and obese patients and their families to improve their overall health. Objective 1: By December 31, 2014, 80% of overweight or obese patients and/or their families will make a health-related goal with counseling from their provider. Goal 3: To encourage overweight and obese children and/or their families to make healthier lifestyle choices associated with nutritional choices, activity, sleep, and TV viewing. Objective 1: By December 31, 2014, 40% of overweight or obese patients will demonstrate improvement in at least one lifestyle choice area within six months. By June 30, 2016, this number will increase to 50%; by December 31, 2017, this number will increase to 60%. Goal 4: To provide more consistent referrals to community resources for overweight and obese children. Objective 1: By December 31, 2014, CHS will refer 80% of children diagnosed as overweight or obese and who report more than average readiness to change to the Healthy Living Program. By June 30, 2016, this number will increase to 90%; by December 31, 2017, this number will increase to 100%. Objective 2: By December 31, 2014, 30% of patients referred to the Healthy Living Program will participate in the program. By June 30, 2016, this number will increase to 40%; by December 31, 2017, this number will increase to 50%. Objective 3: By December 31, 2014, CHS will provide 30% of children diagnosed as overweight or obese with vouchers to the Commerce City Recreation Center. By June 30, 2016, this number will increase to 40%; by December 31, 2017, this number will increase to 50%. Goal 5: To provide more consistent screening of obesity measures such as BMI, blood pressure, lipids, hemoglobin A1C, fasting glucose, and ALT. Objective 1: By December 31, 2014, 100% of children seen for well-child checks will be screened for weight and height. Objective 2: By December 31, 2014, 100% of children ages 2 and older seen for well-child checks will be screened for BMI and blood pressure. Objective 3: By December 31, 2014, 30% of children diagnosed as overweight or obese will be seen every three months for follow-up. By June 30, 2016, this number will increase to 40%; by December 31, 2017, this number will increase to 50%. Methodology undertaken to meet project goals While CHS has made huge strides in the identification and treatment of obesity, there is much more we can do. Strategies and activities associated with the Get Healthy! project are outlined in more detail below. New components of this project will include: Establishing guidelines and protocols around obesity treatment. Improvement and expansion of a dedicated obesity registry (HeartSmartKids). Goal-setting with families on obesity. Hiring of a Patient Navigator to work with families on follow-through. Tracking and evaluation of outcomes in conjunction with Department of Pediatric Nutrition at UCSOM. CHS recognizes that offering small rewards can yield significant results and enhance retention in clinical weight management programs. Thus, incentives will be offered for critical steps of care such as returning for follow-up appointments, demonstrating and documenting self-monitoring goals, meeting goals, etc. Incentives will include active play tools that encourage the physical activity as balls, pedometers, jump ropes, and frisbees.

Coordination:

Following is a list of other agencies associated with this project: Adams 14 -- space and access to students/patients. Adams 50 -- space and access to students/patients. University of Colorado College of Nursing -- additional staffing for program. The primary partner for this project is the Department of Pediatric Nutrition at UCSOM. They are providing training and access to the Department's Healthy Living Program.

Evaluation:

CHS intends to collaborate with UCSOM and HeartSmartKids in the evaluation of the Get Healthy! project and its associated outcome measures. Matthew Haemer, MD, is an expert at evaluating these types of projects, and CHS will contract with Dr. Haemer specifically in the evaluation of the project.

Experience to Date:

HeartSmartKids pulled data that Kids First will be using to conduct the return on investment (ROI) analysis on the project. The first time frame of 8/1/2013-7/31/2014 was used for the first data point and compared to a follow up data point in the second time frame of 8/1/2014- 7/31/2015.� 89% of Normal Weight Kids stayed Normal Weight � 9% of Normal Weight Kids became Overweight � 1% of Normal Weight Kids became Obese � 1% of Normal Weight Kids became Underweight� 21% of Overweight Kids became Normal Weight � 51% of Overweight Kids stayed Overweight � 28% of Overweight Kids became Obese� 1% of Obese Kids became Normal Weight � 15% of Obese Kids became Overweight � 84% of Obese Kids remained Obese. This data indicates that overall: � In general, Kids First normal weight patients are staying normal weight. � Patients who are diagnosed as being overweight are not becoming obese at the rate that has been shown in other populations (40% being the most common statistic). � Sixteen percent (16%) of our patients who were diagnosed as obese dropped weight categories which will significantly improve their current and long term health. � This data does not capture patients who are losing weight and improving their health, but not changing BMI categories. This is why these patients are better evaluated by looking at their BMI and z-score changes. This data will be available on the December 2016 Performance Narrative.