Scientific Program

Abstract:

Introduction: In the United States, the prevalence of unhealthy weight among children has increased significantly, especially in communities served by Community Health Centers (CHCs). Families receiving primary care at CHCs face systemic and structural inequities that introduce barriers to healthy weight. CHCs play a critical role in addressing disparities through education, prevention, and the management of obesity and comorbidities. However, there is consensus that current research and quality initiatives have not sufficiently engaged CHCs in design and implementation.

This initiative leveraged a mixed-methods, community stakeholder-driven approach to:

1. Identify priorities for research and improvement science related to the prevention of chronic diseases beginning in childhood.
2. Describe the trends of obesity and metabolic risk factors in CHCs.
3. Co-design investigations that lead to improvements in early identification of chronic diseases.

Methods: We engaged a national network of over 70 CHCs in identifying priorities for reducing the burden of chronic conditions associated with obesity in a mixed-methods study. Qualitative data was collected to identify study priority areas that reflect high clinical significance, feasibility, and usefulness in practice. Using this information, a quantitative analysis using Electronic Health Record data was conducted to describe the prevalence of obesity and missed opportunities to improve the early detection and management of obesity-related comorbidities. Specifically, we described:

1. The longitudinal trends in obesity across a national cohort of CHCs.
2. The current state of guideline-concordant screenings for chronic conditions.
3. Improvement in key metrics using Improvement Science frameworks. A pilot project across 4 CHCs specifically tested interventions to improve screening rates for Diabetes and Liver Disease.

Results: Over 50,000 patients across 19 health systems were included in the prevalence study. The prevalence of obesity was higher than national averages; it increased from 2019 to 2021 with the highest prevalence (38%) in children 6-11 years of age. Data revealed significant opportunities for improving guideline-concordant practice in screening for chronic conditions, screening for food insecurity, and follow-up support for lifestyle. For example, less than 50% of eligible children were screened for diabetes and non-alcoholic fatty liver disease. In a pilot study to improve screening rates increased from 48% to 62.5% across 5000 patients.

Conclusions: Engaging community health stakeholders in all phases of research and quality initiatives is essential to ensure the clinical relevance and feasibility of investigations to improve health equity and chronic disease trajectories. The results demonstrate that the prevalence of obesity in resource-limited settings is higher than the national prevalence with a marked increase in unhealthy weight status pre- and post-pandemic. This project underscores the need for interventions that are feasible in settings that serve marginalized populations who are at the highest risk for chronic conditions and health inequities.

Biography:

Nivedita Mohanty, MD, is Chief Research Officer and Director of Evidence-Based Practice at AllianceChicago. Dr. Mohanty leads efforts that leverage the HIT infrastructure and partnerships to enhance quality, evidence-based practices in community health and generate new evidence through patient outcomes and health services research. Dr. Mohanty is a pediatrician at Erie Family Health Center. As Assistant Professor at Northwestern University’s Feinberg School of Medicine, she has clinical responsibilities at Lurie Children’s Hospital and Prentice Women’s Hospital. She volunteered on medical service trips to help children with HIV, disabilities, burns, congenital heart disease, and cranio-facial defects in Africa, Asia, South and Central Americas.