Purpose: More than half of the infants in the United States participate in the Women, Infants and Children (WIC) program while simultaneously receiving preventive care from pediatricians. Parents obtain feeding and parenting advice from both, however the care is uncoordinated and information maybe conflicting. Our purpose was to evaluate the perspectives of pediatricians and WIC nutritionists about the opportunities and challenges of coordinating care to prevent infant rapid weight gain before 6 months of age. Methods: We used a semi-structured interview guide to gather the perspectives of pediatricians (N= 13) and WIC nutritionists (N= 35) in a Mid-Atlantic state. Investigators used a grounded theory approach to independently code-transcripts. Cross-cutting categories and emerging themes across both groups are reported. Results: Key themes regarding opportunities from both the pediatricians and WIC nutritionists include: 1) Data sharing between clinical and community settings would improve quality of communication about care in either setting by removing mom as the messenger; 2) Care coordination would allow clinical and community partners to provide a unified front to deliver patient-centered messages for a higher dose of evidence-based prevention messaging; and 3) Open lines of communication between clinical and community partners should utilize health information technology strategies as well as informal educational sessions to enable relationship building. Both parties struggle with the uncertainty regarding information communicated by the mother regarding advice from other settings that may explain conflicts regarding adding cereal to the bottle, juice, and the introduction of solids. Pediatricians and WIC share a struggle in engaging mothers during preventive care due to parental preoccupation with electronic media. Both sectors would benefit from an understanding of guidelines, policies, practices, strengths and capabilities of one another. Such understanding can serve as a relational foundation for practical electronic data sharing that fosters care coordination. Bi-directional, continuous data sharing using templates and allowing for free-text, with appropriate data security, was recommended. Conceptually, both parties are uncertain but concerned about the time burden to review each other's notes. Clinicians perceive potentially greater time savings than WIC as time spent discussing feeding could be reduced when these topics have been discussed by nutritionists and when WIC notes are incorporated directly into the infant's electronic health record. Similarly, health information technology strategies should be utilized to identify discreet data to share from WIC to the clinician to reduce documentation burden. Conclusion: Clinical and community sectors are optimistic about the potential to coordinate preventative care to promote more productive interactions between professionals and with parents to optimize healthy infant growth and parenting practices.
Perceptions About Care Coordination Between Pediatricians and Women, Infants and Children (wic) for Early Childhood Obesity Prevention
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Grant Morris, Lisa Bailey-Davis, William Cochran, Lindsey Hess, Michele Marini, Jacob Mowery, Shawnee Lutcher, Jennifer Savage, Jennifer Franceschelli Hosterman; Perceptions About Care Coordination Between Pediatricians and Women, Infants and Children (wic) for Early Childhood Obesity Prevention. Pediatrics January 2018; 141 (1_MeetingAbstract): 590. 10.1542/peds.141.1MA6.590
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