Advanced health information technologies to engage parents, clinicians, and community nutritionists in coordinating responsive parenting care: Descriptive case series of the women, infants, and children enhancements to early healthy lifestyles for baby (WEE Baby) care randomized controlled trial

Samantha M.R. Kling*, Holly A. Harris, Michele Marini, Adam Cook, Lindsey B. Hess, Shawnee Lutcher, Jacob Mowery, Scott Bell, Sandra Hassink, Shannon B. Hayward, Greg Johnson, Jennifer Franceschelli Hosterman, Ian M. Paul, Christopher Seiler, Shirley Sword, Jennifer S. Savage, Lisa Bailey-Davis

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)

Abstract

Background: Socioeconomically disadvantaged newborns receive care from primary care providers (PCPs) and Women, Infants, and Children (WIC) nutritionists. However, care is not coordinated between these settings, which can result in conflicting messages. Stakeholders support an integrated approach that coordinates services between settings with care tailored to patient-centered needs. Objective: This analysis describes the usability of advanced health information technologies aiming to engage parents in self-reporting parenting practices, integrate data into electronic health records to inform and facilitate documentation of provided responsive parenting (RP) care, and share data between settings to create opportunities to coordinate care between PCPs and WIC nutritionists. Methods: Parents and newborns (dyads) who were eligible for WIC care and received pediatric care in a single health system were recruited and randomized to a RP intervention or control group. For the 6-month intervention, electronic systems were created to facilitate documentation, data sharing, and coordination of provided RP care. Prior to PCP visits, parents were prompted to respond to the Early Healthy Lifestyles (EHL) self-assessment tool to capture current RP practices. Responses were integrated into the electronic health record and shared with WIC. Documentation of RP care and an 80-character, free-text comment were shared between WIC and PCPs. A care coordination opportunity existed when the dyad attended a WIC visit and these data were available from the PCP, and vice versa. Care coordination was demonstrated when WIC or PCPs interacted with data and documented RP care provided at the visit. Results: Dyads (N=131) attended 459 PCP (3.5, SD 1.0 per dyad) and 296 WIC (2.3, SD 1.0 per dyad) visits. Parents completed the EHL tool prior to 53.2% (244/459) of PCP visits (1.9, SD 1.2 per dyad), PCPs documented provided RP care at 35.3% (162/459) of visits, and data were shared with WIC following 100% (459/459) of PCP visits. A WIC visit followed a PCP visit 50.3% (231/459) of the time; thus, there were 1.8 (SD 0.8 per dyad) PCP to WIC care coordination opportunities. WIC coordinated care by documenting RP care at 66.7% (154/231) of opportunities (1.2, SD 0.9 per dyad). WIC visits were followed by a PCP visit 58.9% (116/197) of the time; thus, there were 0.9 (SD 0.8 per dyad) WIC to PCP care coordination opportunities. PCPs coordinated care by documenting RP care at 44.0% (51/116) of opportunities (0.4, SD 0.6 per dyad). Conclusions: Results support the usability of advanced health information technology strategies to collect patient-reported data and share these data between multiple providers. Although PCPs and WIC shared data, WIC nutritionists were more likely to use data and document RP care to coordinate care than PCPs. Variability in timing, sequence, and frequency of visits underscores the need for flexibility in pragmatic studies.

Original languageEnglish
Article numbere22121
JournalJMIR Pediatrics and Parenting
Volume3
Issue number2
DOIs
Publication statusPublished - Jul 2020

Bibliographical note

Funding Information:
The authors recognize and appreciate the support of the following individuals who contributed this study: Alison Baker, MS; Janice L Leibhart, MS; and Jeanne Lindros, MPH, with the Institute for Healthy Childhood Weight, and William J Cochran, MD; Peggy Lovecchio, RN; Grant A Morris, MD; Jason Socrates, and Alexes Samonte, MD, with Geisinger. We also acknowledge the vast contributions of the late Leann Birch, PhD, of The Pennsylvania State University and University of Georgia. This project is supported by the Health Resources and Services Administration of the US Department of Health and Human Services (grant number R40MC28317) Maternal and Child Health Field-initiated Innovative Research Studies Program. Under the umbrella of becoming a learning health care system, Geisinger has funded internal quality improvement grants to provide iPads and kiosks to clinics.

Funding Information:
This project is supported by the Health Resources and Services Administration of the US Department of Health and Human Services (grant number R40MC28317) Maternal and Child Health Field-initiated Innovative Research Studies Program. Under the umbrella of becoming a learning health care system, Geisinger has funded internal quality improvement grants to provide iPads and kiosks to clinics.

Publisher Copyright:
© Samantha MR Kling, Holly A Harris, Michele Marini, Adam Cook, Lindsey B Hess, Shawnee Lutcher, Jacob Mowery, Scott Bell, Sandra Hassink, Shannon B Hayward, Greg Johnson, Jennifer Franceschelli Hosterman, Ian M Paul, Christopher Seiler, Shirley Sword, Jennifer S Savage, Lisa Bailey-Davis. Originally published in JMIR Pediatrics and Parenting (http://pediatrics.jmir.org), 24.11.2020.

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