Testing the efficacy of a technology-assisted intervention to improve weight management of obese patients within Patient Aligned Care Teams at the VA

项目摘要 项目背景 退伍军人承担着肥胖及其并发症的不成比例的负担。VA目前提供一个 有效的体重管理计划称为移动！，但大多数符合条件的病人都不参加。以来 退伍军人看到他们的初级保健提供者（PCP）平均每年3.6次，初级保健（PC）访问是 这是一个重要的机会，可以为肥胖患者提供体重管理方面的咨询，特别是那些无法控制体重的患者。 或者不想参加搬家！程序.然而，由于PCP往往未能为患者提供咨询， 需要在PACT团队护理模式中促进体重管理咨询。通过 HSR&D CDA研究10-206，我们使用严格的定性方法（患者焦点小组，关键知情人 与PACT工作人员的访谈，以及新软件的可用性测试），以制定MTG干预措施， 整合了健康教练和PACT工作人员的技术辅助咨询，以提供体重管理 咨询使用5A框架（评估，建议，同意，协助，安排），由美国建议 国家预防服务工作队。 项目目标 本研究的目的是：（a）测试MTG干预对体重变化的影响， 行为/临床结果;（B）确定参与干预的退伍军人体重减轻的预测因素 （c）确定MTG的影响 对PACT肥胖相关咨询实践和态度的干预。 项目方法 为了实现这些目标，我们将进行一项关于PACTs的随机对照试验（随机分组， RN护理经理级别）和两个VA站点（纽约和布鲁克林）的392名肥胖退伍军人患者 校园，纽约港医疗保健系统）研究12个月MTG干预的影响， 相比之下，加强护理。MTG干预中的患者将使用MTG工具， 教练咨询，去他们预定的当天PC访问，接受简短的PACT咨询，并接受随访 在12个月内从健康教练那里获得电话指导。MTG工具是一个移动友好的软件 该计划旨在在诊所环境中的平板电脑上交付，以评估生活方式行为， 障碍，提供量身定制的建议和患者教育材料，创建初始减肥和行为改变 目标，并促进健康教练和PACT工作人员的咨询。加强型泌尿外科护理组的患者 将收到患者教育材料（标准VA健康生活信息），并参加他们的计划 当天PC访问。所有患者参与者将在3个月、6个月和12个月时参加随访访视，以评估身体 体重指数、腰围、饮食和体力活动以及目标达成情况。PACT工作人员和健康教练 结果将包括5As相关的能力，以及咨询的质量和频率。

Project Summary Abstract Project Background Veterans shoulder a disproportionate burden of obesity and its co-morbidities. The VA currently offers an effective weight management program called MOVE!, but the majority of eligible patients do not attend. Since Veterans see their primary care providers (PCPs) on average 3.6 times per year, the primary care (PC) visit is an important opportunity to counsel obese patients about weight management, especially patients who cannot or prefer not to attend the MOVE! program. However, since PCPs often fail to counsel patients, interventions are needed to facilitate weight management counseling within the PACT model of team-based care. Through HSR&D CDA study 10-206, we used rigorous qualitative methods (patient focus groups, key informant interviews with PACT staff, and usability testing of novel software) to develop the MTG intervention that integrates technology-assisted counseling by a health coach and PACT staff to deliver weight management counseling using the 5As framework (assess, advise, agree, assist, arrange) as recommended by the United States Preventive Services Task Force. Project Objectives The objectives of this study are to: (a) test the impact of the MTG intervention on weight change and behavioral/clinical outcomes; (b) identify predictors of weight loss in Veterans participating in the intervention group related to goal setting processes and intervention components; and (c) determine the impact of the MTG intervention on PACT obesity-related counseling practices and attitudes. Project Methods To achieve these objectives, we will conduct a cluster randomized controlled trial of PACTs (randomized at RN Care Manager level) and 392 of their obese Veteran patients at two VA sites (New York and Brooklyn campuses, NY Harbor Healthcare System) to study the impact of the 12-month MTG intervention when compared to Enhanced Usual Care. Patients in the MTG intervention will take the MTG tool, receive health coach counseling, go to their scheduled same-day PC visit, receive brief PACT counseling, and receive follow up telephone coaching from the health coach over 12 months. The MTG tool is a mobile-friendly software program designed to be delivered on tablet computers in the clinic setting to assess lifestyle behaviors and barriers, provide tailored advice and patient education materials, create initial weight loss and behavior change goals, and facilitate counseling by the health coach and PACT staff. Patients in the Enhanced Usual Care arm will receive patient education materials (standard VA Healthy Living Messages) and attend their scheduled same-day PC visit. All patient participants will attend follow-up visits at 3-, 6- and 12-months to assess Body Mass Index, waist circumference, diet and physical activity, and goal attainment. PACT staff and health coach outcomes will include 5As-related competency, as well as quality and frequency of counseling.