Informing Change

Berkeley, CA, United States

Informing Change

Berkeley, CA, United States

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Friedman E.G.,Sutter Health | Crowley M.,Alameda Health Consortium | Howard K.A.,Informing Change | Pavel M.P.,Breakthrough Communities
Population Health Management | Year: 2015

This article details the processes and findings of a 3-year demonstration project implementing population health management and the Patient-Centered Medical Home (PCMH) model in 3 community health centers in Alameda County, California. The article provides a first look at the PCMH Continuum, a tool for aiding staff in conceptualizing and implementing complex organizational change. Findings of the project evaluation also are shared, comprising a road map for other organizations looking to implement population health management, panel management, and PCMH. The article reflects on lessons learned and best practices from the demonstration project. © Copyright 2015, Mary Ann Liebert, Inc. 2015.


Ritchie L.D.,University of California | Rosen N.J.,Informing Change | Rosen N.J.,University of California at Berkeley | Fenton K.,University of California at Berkeley | And 4 more authors.
Journal of the Academy of Nutrition and Dietetics | Year: 2016

Background: Breakfast skipping has been associated with obesity. Schools have adopted breakfast policies to increase breakfast participation. Recently, there have been concerns that students in schools where breakfast is served in the classroom may be eating two breakfasts-one at home and one at school-thereby increasing their risk of excessive energy intake and weight gain. Objective: The study objective was to compare the prevalence of not eating breakfast, eating breakfast at home or school only, and eating double breakfasts (home and school) by students in schools with distinct breakfast policies and evaluate the relationship of breakfast policy to energy intake and diet quality. Design: Baseline data were collected in 2011-2012 as part of a cluster randomized controlled trial to evaluate the effectiveness of a school-based intervention to promote fruit and vegetable intake and physical activity in low-resource elementary schools in California. Participants/setting: Participants were 3,944 fourth and fifth graders from 43 schools, 20 served breakfast in the cafeteria before school, 17 served breakfast in the classroom at the start of school, and 6 served "second chance" breakfast (in the cafeteria before school and again at first recess). Statistical analysis: As part of a secondary data analysis, differences in school and individual characteristics by school breakfast policy were assessed by χ2 test of independence or analysis of variance. Associations between school breakfast policy and breakfast eating patterns were assessed. Outcomes included calorie intake at breakfast, total daily calorie intake, and diet quality as measured by the Healthy Eating Index 2010. Control variables included student race/ethnicity, grade, and language spoken at home, and clustering of students by school. Results: Breakfast in the classroom was associated with fewer students not eating breakfast (P<0.001), but more eating breakfast at both home and school (P<0.001). Students in the breakfast in the classroom group did not have higher mean energy intakes from breakfast or higher daily energy intakes that were higher than other breakfast policy groups. The breakfast in the classroom group had higher overall diet quality (P=0.01). Conclusions: No evidence was found to support discontinuation of breakfast in the classroom policy on the basis of concerns that children will eat excess calories. © 2016 Academy of Nutrition and Dietetics.


Au L.E.,University of California at Berkeley | Rosen N.J.,Informing Change | Fenton K.,Seattle Genetics | Hecht K.,University of California at Berkeley | Ritchie L.D.,University of California at Berkeley
Journal of the Academy of Nutrition and Dietetics | Year: 2016

Background: Few studies have assessed the dietary quality of children who eat meals from home compared with school meals according to the 2010 Dietary Guidelines for Americans. Objective: The objective of this study was to examine diet quality for elementary school students in relation to source of breakfast and lunch (whether school meal or from an outside source). Design: An observational study was conducted of students in 43 schools in San Diego, CA, during the 2011-2012 school year. Participants/setting: Fourth- and fifth-grade students (N=3,944) completed a diary-assisted 24-hour food recall. Main outcome measures: The Healthy Eating Index-2010 (HEI-2010) scores of children who ate breakfast and lunch at school were compared with the HEI-2010 scores of children who obtained their meals from home and a combination of both school and home. Statistical analysis: Analysis of variance, χ2 test, and generalized estimating equation models adjusted for age, sex, race/ethnicity, grade, language, and school level clustering were performed. Results: School lunch eaters had a higher mean±standard deviation overall diet quality score (HEI-2010=49.0±11.3) compared with students who ate a lunch obtained from home (46.1±12.2; P=0.02). There was no difference in overall diet quality score by breakfast groups. Students who ate school breakfast had higher total fruit (P=0.01) and whole fruit (P=0.0008) scores compared with students who only ate breakfast obtained from home. Students who ate school foods had higher scores for dairy (P=0.007 for breakfast and P<0.0001 for lunch) and for empty calories from solid fats and added sugars (P=0.01 for breakfast and P=0.007 for lunch). Conclusions: Eating school lunch was associated with higher overall diet quality compared with obtaining lunch from home. Future studies are needed that assess the influence of the Healthy Hunger-Free Kids Act on children's diet quality. © 2016 Academy of Nutrition and Dietetics.


Au L.E.,University of California at Berkeley | Whaley S.,Research and Evaluation | Rosen N.J.,Informing Change | Meza M.,Health Enterprises | Ritchie L.D.,Oakland University
Journal of the Academy of Nutrition and Dietetics | Year: 2016

Background: Although in-person education is expected to remain central to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) service delivery, effective online nutrition education has the potential for increased exposure to quality education and a positive influence on nutrition behaviors in WIC participants. Education focused on promoting healthy breakfast behaviors is an important topic for WIC participants because breakfast eating compared with breakfast skipping has been associated with a higher-quality diet and decreased risk for obesity. Objective: To examine the influences of online and in-person group nutrition education on changes in knowledge, attitudes, and behaviors related to breakfast eating. Design: Randomized-controlled trial comparing the effectiveness of online and in-person nutrition education between March and September 2014. Participants/setting: Five hundred ninety WIC participants from two Los Angeles, CA, WIC clinics were randomly assigned to receive in-person group education (n=359) or online education (n=231). Education focused on ways to reduce breakfast skipping and promoted healthy options at breakfast for parents and their 1- to 5-year-old children participating in WIC. Questionnaires assessing breakfast-related knowledge, attitudes, and behaviors were administered before and after education, and at a 2- to 4-month follow-up. Statistical analysis: Changes within and between in-person and online groups were compared using t tests and χ2 tests. Analysis of covariance and generalized estimating equations were used to assess differences in change between groups. Results: Changes in knowledge between pretest and follow-up at 2 to 4 months were similar between groups. Both groups reported reductions in barriers to eating breakfast due to time constraints, not having enough foods at home, and difficulty with preparation. Increases in the frequency of eating breakfast were greater for both the parent (P=0.0007) and child (P=0.01) in the online group compared with the in-person group during the same time points. Conclusions: Overall, this study demonstrates that both in-person and online nutrition education were effective in increasing breakfast-related knowledge in WIC participants, reducing breakfast skipping, and improving other breakfast-related behaviors, showing the potential usefulness for online education modalities for future WIC services. © 2015 Academy of Nutrition and Dietetics.


Au L.E.,University of California at Berkeley | Whaley S.,Health Enterprises | Rosen N.J.,Informing Change | Meza M.,Health Enterprises | Ritchie L.D.,Oakland University
Journal of the Academy of Nutrition and Dietetics | Year: 2016

Background: Although in-person education is expected to remain central to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) service delivery, effective online nutrition education has the potential for increased exposure to quality education and a positive influence on nutrition behaviors in WIC participants. Education focused on promoting healthy breakfast behaviors is an important topic for WIC participants because breakfast eating compared with breakfast skipping has been associated with a higher-quality diet and decreased risk for obesity. Objective: To examine the influences of online and in-person group nutrition education on changes in knowledge, attitudes, and behaviors related to breakfast eating. Design: Randomized-controlled trial comparing the effectiveness of online and in-person nutrition education between March and September 2014. Participants/setting: Five hundred ninety WIC participants from two Los Angeles, CA, WIC clinics were randomly assigned to receive in-person group education (n=359) or online education (n=231). Education focused on ways to reduce breakfast skipping and promoted healthy options at breakfast for parents and their 1- to 5-year-old children participating in WIC. Questionnaires assessing breakfast-related knowledge, attitudes, and behaviors were administered before and after education, and at a 2- to 4-month follow-up. Statistical analysis: Changes within and between in-person and online groups were compared using t tests and χ2 tests. Analysis of covariance and generalized estimating equations were used to assess differences in change between groups. Results: Changes in knowledge between pretest and follow-up at 2 to 4 months were similar between groups. Both groups reported reductions in barriers to eating breakfast due to time constraints, not having enough foods at home, and difficulty with preparation. Increases in the frequency of eating breakfast were greater for both the parent (P=0.0007) and child (P=0.01) in the online group compared with the in-person group during the same time points. Conclusions: Overall, this study demonstrates that both in-person and online nutrition education were effective in increasing breakfast-related knowledge in WIC participants, reducing breakfast skipping, and improving other breakfast-related behaviors, showing the potential usefulness for online education modalities for future WIC services. © 2016 Academy of Nutrition and Dietetics.

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