Peer-reviewed article
Enhancing Pediatric Obesity Management through Quality Improvement: A Hybrid Approach to Intensive Health Behavior and Lifestyle Treatment in Primary Care.
Skrocki ET, Sarabia C, Xiong S, Talmi A ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study describes a quality improvement initiative at an urban primary care clinic designed to increase referrals to and participation in intensive health behavior and lifestyle treatment (IHBLT) programs for children with obesity. The team tested multiple changes including provider education, culturally tailored materials, and a hybrid in-person and virtual program model. Participation and treatment intensity improved and were sustained, though referral volume remained stable.
Key points
- Baseline performance showed low referral volume, limited participation, and insufficient treatment intensity for pediatric obesity treatment
- The intervention combined provider education, standardized culturally tailored materials, and a hybrid in-person-and-virtual program structure
- Program participation and intervention intensity demonstrated sustained improvement using statistical process control analysis
- Referral volume showed primarily common-cause variation and remained stable throughout the initiative
- The hybrid IHBLT model addresses logistical and equity-related barriers in primary care settings
Limitations
The report describes a quality improvement initiative at a single urban academic institution and does not include a control comparison group. Outcomes are measured as process metrics (referrals, participation, intensity) rather than clinical health outcomes for children with obesity.
Abstract
Introduction Intensive health behavior and lifestyle treatment (IHBLT) programs can improve weight and reduce comorbidities for children with obesity, but implementation in primary care remains limited. Baseline performance at our institution showed low referral volume, limited participation, and insufficient treatment intensity, indicating gaps in program reach and adoption. Methods Utilizing the model for improvement, we led a quality improvement initiative in a large urban academic primary care clinic to increase IHBLT referrals, participation, and treatment intensity. Sequential plan-do-study-act cycles tested provider education, standardized and culturally tailored materials, a hybrid in-person-and-virtual program structure, and engagement strategies. We tracked three process measures: referrals, participation, and program intensity. We tracked outcomes using individuals-moving-range (X-mR) statistical process control charts. Results Statistical process control analysis demonstrated that program participation and intervention intensity met Provost criteria for a sustained shift, whereas referral volume demonstrated primarily common-cause variation. Improvements in participation and intervention intensity were maintained over time, with centerlines recalculated to reflect updated process performance. Moving range charts indicated stable variation across all measures. Conclusions An iterative, context-responsive system redesign improved the delivery of evidence-based pediatric obesity treatment in our primary care setting. The hybrid IHBLT model, combining in-person visits and technology-supported touchpoints, was associated with sustained gains in participation and treatment intensity, whereas referral volume remained stable. This pragmatic approach leverages existing resources and offers a feasible pathway for primary care clinics seeking to implement guideline-concordant IHBLT while addressing common logistical and equity-related barriers.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Quality improvement initiative including provider education, standardized and culturally tailored materials, hybrid in-person-and-virtual program structure, and engagement strategies
- Population
- Children with obesity in a large urban academic primary care clinic
Key finding
Program participation and intervention intensity met Provost criteria for sustained shift and were maintained over time
ET et al. · Europe PMC · 28 Jul 2026