STAR uses health information technology to help clinicians and parents adopt evidence-based strategies to reduce childhood obesity.
STAR is the Study of Technology to Accelerate Research, an obesity intervention for 6 to 13 year old children with a body mass index (BMI) ≥ 95th percentile. We use mobile and health information technology to help clinicians and parents use evidence-based strategies to improve childhood obesity management. We implemented decision support tools in the electronic health record (EHR) that are delivered to pediatric clinicians at annual patient visits, and health coaches provide direct-to-parent support, including telephone coaching and interactive text messages to enhance these clinical efforts.
Participating clinical practices use a modified EHR that includes a BestPractice® alert that pops up for clinicians at the time of a well child care visit with a child between the ages of 6-13 years with a BMI ≥ 95th percentile. The alert contains links to the CDC growth charts, existing childhood obesity CER evidence, and a pre-populated well child visit template specific for obesity that provides guidance for proper documentation of diagnosis codes and lab orders, as well as a link to patient education materials and a clinician website of obesity-related resources. We also gave each clinical practice STAR posters to display that summarize the behavioral goals and can cue parents to talk about them with their children and their clinician.
The primary behavioral goals of STAR are:
• Sleep at least 10 hours a night
• No more than 2 hours per day of screen time
• Get at least 1 hour of moderate to vigorous physical per day
• Drink water. Have 0 sugary drinks.
We promote ‘10-2-1-0’ as an easy-to-remember slogan of our goals.
In addition to the STAR clinical efforts, we also directly reach out to parents. Health coaches conduct calls with parents to assess how children are doing on each of the primary STAR behaviors and to motivate them to work towards the goals. Coaching calls are made four times over the course of one year. Between calls, we mail parents educational materials on the targeted health behaviors.
In addition, parents are invited to participate in an interactive text messaging campaign. Texts provide behavior change support for the parent and family. In most weeks, parents receive two text messages:
1) A self-monitoring message that generates an immediate automated feedback response message when parents reply to it.
2) A skills training message that offers an educational “tip” about one of the target behaviors.
Parents who choose not to receive texts, have the option to receive messages via email.
After one year, we will look at how the Pediatric Obesity BPA and SmartSet affect clinical outcomes, such as diagnosis documentation and referrals, as well as child-level outcomes including BMI and weight-related behaviors, with and without health coaching support.
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STAR is a collaboration between an integrated health delivery system, Harvard Vanguard Medical Associates (HVMA), and an academic institution, the Department of Population Medicine (DPM) at Harvard Medical School and Harvard Pilgrim Health Care Institute. The project seeks to use technology to help clinicians and parents use evidence-based strategies to improve childhood obesity management.
STAR is led by Principal Investigator, Dr. Elsie Taveras and HVMA Principal Investigator Dr. Richard Marshall. The project is directed by Christine Horan, MPH, a senior project manager at DPM with 8 years of experience overseeing childhood obesity interventions. The health coaching component is led by Sarah Price, MPH, senior health educator who has worked with Dr. Taveras since 2005.