Evidence map›Paper›PMID 25810449›Full record

Trial reportClinical trials (London, England)2015

Design of a cluster-randomized trial of electronic health record-based tools to address overweight and obesity in primary care.

Heather J Baer, Christina C Wee, Katerina DeVito, E John Orav, Joseph P Frolkis, Deborah H Williams, Adam Wright, David W Bates

Open access · greenAbstract readRandomized Controlled TrialPragmatic Clinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Clinical trials (London, England), 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed, 4 pooled it
2.0field-weighted citation impact, top 12% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

11 citing papers in PubMed, 4 syntheses or guidelines pooled it, 15 citations in OpenAlex.

  1. Pooled it
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  5. Trial
  6. Article
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  9. Review
  10. What works and why in the identification and referral of adults with comorbid obesity in primary care: A realist review.Obesity reviews : an official journal of the International Association for the Study of Obesity · 2020
    Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 3 institutions in 1 country.

Heather J BaerDivision of General Internal Medicine & Primary Care, Brigham and Women's Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA hbaer@partners.org.
Christina C WeeHarvard Medical School, Boston, MA, USA Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Katerina DeVitoDivision of General Internal Medicine & Primary Care, Brigham and Women's Hospital, Boston, MA, USA.
E John OravDivision of General Internal Medicine & Primary Care, Brigham and Women's Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA.
Joseph P FrolkisDivision of General Internal Medicine & Primary Care, Brigham and Women's Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA.
Deborah H WilliamsDivision of General Internal Medicine & Primary Care, Brigham and Women's Hospital, Boston, MA, USA.
Adam WrightDivision of General Internal Medicine & Primary Care, Brigham and Women's Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA.
David W BatesDivision of General Internal Medicine & Primary Care, Brigham and Women's Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA Partners HealthCare, Boston, MA, USA Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA.
Brigham and Women's Hospital · USBeth Israel Deaconess Medical Center · USMass General Brigham · US

Funding

Patient Oriented Research and Mentorship Program in ObesityK24DK087932 · NIDDK · BETH ISRAEL DEACONESS MEDICAL CENTER · PI WEE, CHRISTINA C · 2011 to 2015
$955k
Use of Electronic Health Records for Addressing Overweight and Obesity in PrimaryK01HS019789 · AHRQ · BRIGHAM AND WOMEN'S HOSPITAL · PI BAER, HEATHER JOANNE · 2010 to 2014
$667k
AHRQ HHS K01 HS019789AHRQ HHS K01-HS-019789NIDDK NIH HHS K24 DK087932NIDDK NIH HHS K24-DK-087932
6 · The paper itself

Abstract

backgroundPrimary care providers often fail to identify patients who are overweight or obese or discuss weight management with them. Electronic health record-based tools may help providers with the assessment and management of overweight and obesity. PURPOSE: We describe the design of a trial to examine the effectiveness of electronic health record-based tools for the assessment and management of overweight and obesity among adult primary care patients, as well as the challenges we encountered.

methodsWe developed several new features within the electronic health record used by primary care practices affiliated with Brigham and Women's Hospital in Boston, MA. These features included (1) reminders to measure height and weight, (2) an alert asking providers to add overweight or obesity to the problem list, (3) reminders with tailored management recommendations, and (4) a Weight Management screen. We then conducted a pragmatic, cluster-randomized controlled trial in 12 primary care practices.

resultsWe randomized 23 clinical teams ("clinics") within the practices to the intervention group (n = 11) or the control group (n = 12). The new features were activated only for clinics in the intervention group. The intervention was implemented in two phases: the height and weight reminders went live on 15 December 2011 (Phase 1), and all of the other features went live on 11 June 2012 (Phase 2). Study enrollment went from December 2011 through December 2012, and follow-up ended in December 2013. The primary outcomes were 6-month and 12-month weight change among adult patients with body mass index ≥25 who had a visit at one of the primary care clinics during Phase 2. Secondary outcome measures included the proportion of patients with a recorded body mass index in the electronic health record, the proportion of patients with body mass index ≥25 who had a diagnosis of overweight or obesity on the electronic health record problem list, and the proportion of patients with body mass index ≥25 who had a follow-up appointment about their weight or were prescribed weight loss medication. LESSONS LEARNED: We encountered challenges in our development of an intervention within the existing structure of an electronic health record. For example, although we decided to randomize clinics within primary care practices, this decision may have introduced contamination and led to some imbalance of patient characteristics between the intervention and control practices. Using the electronic health record as the primary data source reduced the cost of the study, but not all desired data were recorded for every participant.

conclusionDespite the challenges, this study should provide valuable information about the effectiveness of electronic health record-based tools for addressing overweight and obesity in primary care.

Indexed as

Electronic Health RecordsPhysician-Patient RelationsPhysicians, Primary CareCommunicationFemaleHumansMaleMassachusettsMiddle AgedObesityResearch Designelectronic health recordsobesityOverweightprimary care

Identifiers

PMID25810449
PMCPMC4863225
OpenAlexW2170613957

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.