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

项目摘要摘要 项目背景 退伍军人背负着不成比例的肥胖症及其并发症的负担。退伍军人事务部目前提供 名为Move！的有效体重管理计划，但大多数符合条件的患者没有参加。自.以来 退伍军人平均每年见初级保健提供者(PCP)3.6次，初级保健(PC)拜访次数为 这是向肥胖患者提供体重管理建议的重要机会，尤其是那些无法控制体重的患者。 还是宁可不参加搬家！程序。然而，由于初级保健医生往往不能为患者提供咨询，干预措施 在基于团队的护理的PACT模式下，需要促进体重管理咨询。穿过 HSR&D CDA研究10-206，我们使用了严格的定性方法(患者焦点小组、关键信息者 与PACT员工的访谈，以及新软件的可用性测试)，以开发MTG干预 整合健康教练和PACT工作人员的技术辅助咨询，提供体重管理 按照美国的建议，使用5AS框架(评估、建议、同意、协助、安排)进行咨询 国家预防服务工作组。 项目目标 这项研究的目的是：(A)测试MTG干预对体重变化和 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 与目标设定进程和干预组成部分有关的小组；以及(C)确定中期目标的影响 对PACT肥胖相关咨询做法和态度的干预。 项目方法 为了达到这些目标，我们将进行一项关于PACTS的整群随机对照试验(在 RN关怀经理级别)和他们在两个退伍军人事务部(纽约和布鲁克林)的392名肥胖退伍军人 研究为期12个月的MTG干预的影响，当 与增强的日常护理相比。患者在MTG干预中将服用MTG工具，获得健康 教练咨询，前往他们预定的当天PC访问，接受简短的契约咨询，并接受关注 在超过12个月的时间里，接受健康教练的电话辅导。MTG工具是一款移动友好的软件 旨在通过临床环境中的平板电脑提供的计划，以评估生活方式行为和 障碍，提供量身定制的建议和患者教育材料，创造最初的减肥和行为改变 目标，并促进健康教练和PACT工作人员的咨询。加强日常护理的患者 将收到患者教育材料(标准退伍军人健康生活信息)，并参加他们预定的 当天的PC访问。所有患者都将在3个月、6个月和12个月时接受随访，以评估身体状况 体重指数、腰围、饮食和体力活动，以及目标实现情况。PACT员工和健康教练 结果将包括与5A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.