Clinical Decision Support for Collaborative Diet Goal Setting in Primary Care

Obesity is a significant health issue and is a risk factor for a number of chronic diseases, including type 2 diabetes, cardiovascular diseases, and certain types of cancer. Seven out of 10 Americans die from a chronic illness, costing approximately 1.3 trillion dollars in national healthcare expenditures annually. Studies show that the prevalence of obesity is disproportionally higher among lower socioeconomic and racial and ethnic minority populations, greatly impacting communities who may have inadequate access to resources and education around healthy eating and behavior. Effective dietary behavior change interventions have the potential to positively impact millions of Americans affected by obesity and diet-related chronic disease, with associated benefits for health equity and healthcare system burden.

Primary care providers (PCPs) are instrumental to address and promote dietary behavior change in chronic disease prevention and management. However, PCPs are often missing important diet information about their patients and may lack the training and time needed for effective nutrition counseling. This research will use clinical decision support (CDS) to capture patient data and assist providers in adopting brief, evidence-based collaborative goal setting to improve diet. The patient-specific data-driven tool, Diet Goal CDS, will be enhanced to analyze patient diet history data and provide an automatically processed list of personalized goals to aid patient-provider communication.

The specific aims of the project are as follows:

• Transform the successful prototype Diet Goal CDS 1.0 into Diet Goal CDS 2.0, a user-centered, electronic health record- and workflow-compatible CDS. 
• Optimize feasibility and acceptance of the CDS tool in a lab setting. 
• Deploy Diet Goal CDS 2.0 via primary care providers in a pilot cluster randomized controlled trial. 

The research team plans to enroll patients, clinical staff, and primary care providers to participate in the system interface development to enhance the usability of the tool. Interviews and observations will occur throughout the intervention to assess usability. User testing will be conducted through videotaped observations, surveys, and interviews. The team then plans to refine and pilot the Diet Goal CDS through a randomized controlled trial to observe behavior change among recruited patients and clinicians.

The overall goal of this research is to provide accessible and personalized data to primary care providers to deliver behavior change counseling among patients with obesity. The research team foresees benefits of embedding access into the clinical workflow servicing patients experiencing health disparities. By simplifying and automating the analysis of patient diet history, PCPs will have more opportunity to address dietary behavior change and may reduce the rate of obesity, making the tool a cost-effective intervention.