O1032: Results of Five Rounds of a Quality Improvement Project to Optimize Infant and Toddler Feeding for Obesity Prevention in Children Under Two

Purpose/Objectives: Evidence supports the “first 1000 days” (conception to ~age 2) as critical to optimal health and obesity prevention. Studies have identified gaps in the comprehensiveness of care provided to support healthy lifestyles during visits with children under 2. The Optimize Infant and Toddler Feeding for Obesity Prevention project is a 19-week, virtual, quality improvement (QI) collaborative, developed to address these gaps, with the global aim of fostering healthy behaviors and healthy weight in all children from birth to 2, in the service of fostering a lifelong trajectory of optimal health. Since 2020, 52 primary care teams have completed 5 annual rounds (R): (R1=16; R2=11; R3=10; R4=9; R5=6). The objective of this analysis was to assess improvements to comprehensive care provided across 5 project rounds.

Design/Methods: Key Drivers and provided trainings and resources were designed to facilitate comprehensive child/family-centered preventive care. Specific improvement aims encompass assessments of a child’s pre/peri-natal risks and growth and both assessments and counseling on dietary intake/nutrition, the parenting/home lifestyle environment and social determinants of health. An additional specific aim to support accurate weighing and measuring was discussed during R3 and formally added for R4 but discontinued for R5. Teams engaged in iterative Plan-Do-Study-Act cycles and submitted 20 randomly selected charts from well visits with children < 2 years 3 times during the collaborative (T1-T3), with an additional "monitoring" data cycle held ~6 mo. later (T4). Data were used to track 8 clinical measures, 6 of which encompassed many possible subtopics, to support the breadth of tailored care (Table). To evaluate comprehensiveness of care, total assessments and counseled topics per chart, including sub-topics, were calculated during each round. Totals at T3 and T4 were compared with those at T1 by independent samples t-tests.

Results: Values for total assessments and counseled topics typically increased progressively over time and were significantly improved from baseline at both T3 (end of collaborative) and T4 (monitoring cycle) (Figure). Exceptions occurred during rounds for which an extra aim was discussed (R3) or added (R4), such that increases in total assessments were delayed (R3) or not sustained (R4). R4 values also appeared lower in general. During R5, after removing this extra aim, robust significant increases in total assessments and counseled topics from baseline were again observed at both T3 and T4. Specific improvements varied by round but were most consistent for pre/perinatal risk assessments and assessments and counseling of the parent/home lifestyle environment (e.g., sleep, responsive feeding).

Conclusion/Discussion: Results support improved comprehensiveness of assessments and counseling provided by teams participating in a 19-week QI project to prevent obesity and support optimal health for children under 2 years.R4 results suggest limitations to adding more specific aims to this very brief, successful QI project.