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

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. Trial Registration ClinicalTrials.gov NCT03482908; https://clinicaltrials.gov/ct2/show/NCT03482908 International Registered Report Identifier (IRRID) RR2-10.1186/s12887-018-1263-z

Infant Food Responsiveness in the Context of Temperament and Mothers' Use of Food to Soothe

“…Enrolled dyads were randomized into a 6-month responsive parenting intervention group ( n = 131) or a standard care control group ( n = 157). In addition, care for mother-infant dyads assigned to the responsive parenting intervention group was coordinated and integrated across pediatric PCPs and WIC settings using advanced Health Information Technology strategies ( 29 ). This study was approved by the Institutional Review Boards of The Pennsylvania State University and Geisinger.…”

WIC staff and healthcare professional perceptions of an EHR intervention to facilitate referrals to and improve communication and coordination with WIC: A qualitative study

“…To our knowledge, this study is one of the few to evaluate perceptions of an innovative EHR-based WIC screening and referral tool and electronic data sharing with WIC. One prior qualitative study from the WIC Enhancements to Early Health Lifestyles for Baby (WEE Baby) intervention involving automated, bi-directional, and continuous data sharing between WIC and healthcare electronic systems demonstrated similar findings that integrated data systems could encourage WIC-healthcare information sharing to improve care coordination, and a quantitative study revealed feasibility and usability of data sharing among all parties [ 17 , 18 ]. Another quantitative WEE Baby study demonstrated that although the intervention did not reduce rapid infant weight gain, it was associated with modestly lower weight for age z -scores and body mass index among infants, indicating potential health benefits of EHR-based care coordination between WIC and the healthcare system [ 16 ].…”

“…Within the “outer setting,” several barriers to WIC enrollment were also described, such as difficulty attending in-person appointments, which may require permanent policy solutions. In addition to challenges, several facilitators to implementation were identified across all five CFIR domains, demonstrating that an EHR-based intervention provides an opportunity for cross-sector data sharing and improved care coordination [ 17 , 18 ].…”

Resource mobilization combined with motivational interviewing to promote healthy behaviors and healthy weight in low-income families: An intervention feasibility study

“…18,25 Few obesity prevention studies have systematically included connection to resources, and none combined connection to resources with a MI-based intervention. 95,96 The closest study design to ours provided predominantly diet and physical activity resources, with more limited resources for other needs. 71 Prevention studies using MI with families are rare.…”