CHAPTER 21: SYSTEMS OF CARE AND QUALITY IMPROVEMENT: GUIDING THE CARE OF THE CHILD WITH OBESITY

INTRODUCTION

This chapter will address the following American College of Graduate Medical Education competencies: systems-based practice and practice-based learning and improvement.

Systems-Based Practice: This chapter will help the pediatric health care provider understand systems level models of care and increase his or her awareness of the larger system of health care delivery that will improve their ability to interact with the system to optimize patient outcomes.

Practice-Based Learning and Improvement: This chapter will help the pediatric health care provider engage in ongoing QI in order to address childhood obesity and obesity-related comorbidities systematically in practice using advances in medical knowledge, epidemiology, and psychosocial and behavioral factors.

SYSTEMS OF CARE AND SUPPORTING MODELS

Systems of care is defined as a family-centered framework to guide optimal care for an individual by providing individualized targeted care and coordinating community-based services to achieve an outcome driven by shared responsibility and participation between the child, family, community, and health providers.¹ Systems of care is particularly relevant to children because they are not independent, cannot fully participate in making decisions, or ensure care is carried out as recommended and must rely on a supportive system to prevent and treat disease. Obesity is a chronic disease characterized by risk factors which are affected by the interplay of influences among family, school, community, and society in the child’s life. This is depicted in the adaptation of Bronfenbrenner’s ecological model² and care of the child with obesity and aligns with the systems of care framework (Figure 21-1).

Brief history of systems of care framework

The systems of care framework began as a mandate to the National Institute of Mental Health (NIMH) from Congress in 1983 to create a guide to care for children with serious mental health impairments. Once developed, the NIMH disseminated the guide through the Child and Adolescent Service System Program, providing funding and technical assistance to the states. Over the next 3 decades, several initiatives funded by the federal and state governments and private entities such as the Robert Wood Johnson Foundation (RWJF) and Anne E. Casey Foundation helped further fine tune, strengthen, and implement a system of care based on the following core values.¹

1. Type and mix of services provided must be dictated by ...