Body Mass Index (BMI) Risk Zones and Variations in Obesity Detection in Veterans with Spinal Cord Injury (SCI)

脊髓损伤 (SCI) 退伍军人的体重指数 (BMI) 风险区和肥胖检测变化

• 批准号: 10331768
• 负责人: Dan Eisenberg
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-01-01 至 2022-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10331768
• 关键词: Affect; American; Body Composition; Body mass index; Caring; Centers for Disease Control and Prevention (U.S.); Chronic Disease; Data; Detection; Deterioration; Effectiveness; Electronic Health Record; Elements; Ensure; Foundations; Future; Goals; Guidelines; Health; Healthcare; Height; Individual; Information Dissemination; Interview; Location; Logistics; Measurement; Measures; Medical; Methodology; Morbidity - disease rate; Obesity; Obesity associated disease; Overweight; Patients; Performance; Physicians; Population; Prevalence; Provider; Public Health; Reporting; Risk; Risk Marker; Services; Special Population; Spinal cord injury; Spinal cord injury patients; System; Thinness; Time; United States Department of Veterans Affairs; Variant; Veterans; Veterans Health Administration; Vulnerable Populations; Weight; Work; World Health Organization; base; cohort; comorbidity; energy balance; global health; implementation design; implementation facilitation; improved; indexing; innovation; military veteran; mortality; muscle form; obesity development; obesity management; obesity risk; screening; standard of care; trend

Background. Obesity is a chronic disease that is associated with significant morbidity and mortality, and is a national healthcare and public health concern. The prevalence of obesity is high among U.S. Veterans, with more than two-thirds being overweight or obese. The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) classify “overweight” and “obesity” as a body mass index (BMI) > 25 kg/m2 and > 30 kg/m2, respectively; as such, BMI assessment is an established standard of care that is supported by the Healthcare Effectiveness Data and Information Set (HEDIS) and is a CMS Physician Quality Reporting System (PQRS) cross-cutting measure. The Departments of Veterans Affairs and of Defense mandate annual universal BMI screening of Veterans for overweight and obesity. Significance. Obesity in individuals with spinal cord injury (SCI) is common due to changes in body composition, changes in energy balance, and a significant decrease in mobility. However, due to these changes, it is likely that BMI underestimates obesity and obesity-related risk in patients with SCI, compared to able-bodied individuals. Because of physical and logistical barriers to conducting height and weight assessments in Veterans with SCI, we suspect that BMI is not consistently measured in this population. Innovation. Appropriate detection and management of obesity in Veterans with SCI relies on consistent measurement of BMI and proper interpretation of BMI when it is assessed. To better understand the burden of obesity in this vulnerable Veteran population and to identify individuals at risk for obesity-related morbidity, we propose to describe system-wide variation in BMI assessment. In addition, we plan to determine the longitudinal associations between BMI and obesity-related risk in Veterans with SCI in order to determine if SCI-specific adjusted BMI risk zones are needed to properly recognize obesity and risk for comorbidity in this population. Specific Aims. Thus, our goals for this project are three-fold: 1) To characterize guideline-concordant BMI assessment in Veterans with SCI in FY16-FY18. 2) To qualitatively understand drivers of facility-level variation in BMI assessment in Veterans with SCI. 3) To evaluate and calibrate SCI-spceific, adjusted BMI-based morbidity risk zones in Veterans with SCI. As such, we will identify Veterans with SCI at risk for obesity-related morbidity whose obesity status, based on current conventional BMI risk zones, would be undetected. Methodology. We will determine facility-level annual proportions of Veterans with SCI that receive guideline-concordant BMI assessment; then identify elements that could influence implementation of BMI assessment strategies by interviewing Veterans and providers in pre-selected facilities; and finally calibrate BMI risk zones in this population by characterizing the functional form of the relationship between BMI and onset of obesity-related comorbidities. Next Steps. By identifying promising practices and key barriers to providing high quality guideline- concordant care to Veterans with SCI, this work hopes to inform practice and system organization for improved care and decreased undersirable variation. In future study, the information collected here will be used to design implementation and improvement strategies to facilitate guideline-concordant practices for Veterans with SCI throughout VHA, and especially in locations with currently low performance. Evaluating the need for adjusted BMI risk-zones specific to Veterans with SCI will allow providers to identify SCI patients who are at risk for obesity and the development of obesity-related disease, who may otherwise be undetected. Dissemination of these results throughout VHA will improve understanding of the risk of obesity and obesity-comorbidity in this vulnerable population.

背景资料。肥胖是一种慢性疾病，与显著的发病率和死亡率有关，而且 这是一个全国性的医疗保健和公共卫生问题。美国退伍军人中肥胖率很高， 超过三分之二的人超重或肥胖。世界卫生组织(WHO)和 美国疾病控制和预防中心(CDC)将“超重”和“肥胖”归类为体重 指数(BMI)分别为25公斤/平方米和30公斤/平方米；因此，体重指数评估是一个既定的标准 由医疗效果数据和信息集(HEDIS)支持的医疗保健，是CMS 医生质量报告制度(PQRS)的交叉措施。退伍军人事务部 国防部规定，每年对退伍军人进行超重和肥胖的普遍BMI筛查。 意义重大。由于身体的变化，脊髓损伤(Sci)患者的肥胖是很常见的。 组成，能量平衡的变化，以及机动性的显著下降。然而，由于这些原因， 相比，BMI很可能低估了脊髓损伤患者的肥胖和肥胖相关风险 给身体健全的人。因为身体和后勤方面的障碍影响了身高和体重 对患有脊髓损伤的退伍军人的评估，我们怀疑BMI在这一人群中没有得到一致的测量。 创新。对患有脊髓损伤的退伍军人进行适当的肥胖检测和处理依赖于 测量BMI并在评估时正确解释BMI。为了更好地理解 在这一脆弱的退伍军人群体中的肥胖负担，并识别与肥胖相关的风险个人 关于发病率，我们建议描述BMI评估中的系统范围的差异。此外，我们计划 依次确定患有脊髓损伤的退伍军人BMI和肥胖相关风险之间的纵向关联 确定是否需要特定于脊髓损伤的调整的BMI风险区来正确识别肥胖和 在这一人群中的共病。 明确的目标。因此，我们对这个项目的目标有三个： 1)研究16-18财年退伍军人BMI与SCI的一致性。 2)定性了解脊髓损伤退伍军人BMI评估中设施水平差异的驱动因素。 3)评估和校准SCI退伍军人基于体重指数调整后的SCI发病危险区。AS 这样，我们将确定患有脊髓损伤的退伍军人有肥胖相关发病率的风险，他们的肥胖状况是基于 目前的传统BMI风险区将不会被发现。 方法论。我们将确定设施级别的退伍军人每年接受SCI的比例 符合指南的BMI评估；然后确定可能影响BMI实施的因素 通过采访预选设施中的退伍军人和提供者来评估战略；并最终校准 通过表征BMI和BMI之间关系的函数形式，确定该人群中的BMI危险区域 与肥胖相关的合并症的发病。 下一步。通过确定提供高质量指南的有前景的实践和关键障碍- 将对退伍军人的关怀与SCI相一致，希望能为实践和系统组织提供参考 改善了护理，减少了不合理的变异。在未来的研究中，这里收集的信息将是 用于设计实施和改进策略，以促进与指南一致的实践 在整个VHA中患有SCI的退伍军人，特别是在目前表现不佳的地点。正在评估 需要针对患有脊髓损伤的退伍军人调整BMI风险区域，这将使提供者能够识别脊髓损伤 有肥胖风险和肥胖相关疾病的患者，否则他们可能是 未被发现。这些结果在整个VHA中的传播将提高对 肥胖症和肥胖症--这一弱势群体的共病。

项目成果

Why may patients with spinal cord injury be overlooked for obesity screening in the Veterans Health Administration? Qualitative research of the perspectives of patients and healthcare providers.

为什么退伍军人健康管理局可能会忽视脊髓损伤患者的肥胖筛查？

• DOI: 10.1080/09638288.2022.2159074
• 发表时间: 2024
• 期刊: Disability and rehabilitation
• 影响因子: 2.2
• 作者: Nevedal,AndreaL;Wu,Justina;LaVela,SherriL;Harris,AlexHS;Frayne,SusanM;Arnow,KatherineD;Barreto,NicolasB;Davis,Kristen;Eisenberg,Dan
• 通讯作者: Eisenberg,Dan

Rates, Variability, and Predictors of Screening for Obesity: Are Individuals with Spinal Cord Injury Being Overlooked?

• DOI: 10.1159/000523917
• 发表时间: 2022-05-01
• 期刊: OBESITY FACTS
• 影响因子: 3.6
• 作者: Eisenberg，Dan;LaVela，Sherri L.;Harris，Alex H. S.
• 通讯作者: Harris，Alex H. S.

The impact of the COVID-19 pandemic on individuals living with spinal cord injury: A qualitative study.

• DOI: 10.1037/rep0000469
• 发表时间: 2023-02
• 期刊: REHABILITATION PSYCHOLOGY
• 影响因子: 2.7
• 作者: LaVela, Sherri L;Wu, Justina;Nevedal, Andrea L;Harris, Alex H S;Frayne, Susan M;Arnow, Katherine D;Barreto, Nicolas B;Davis, Kristen;Eisenberg, Dan
• 通讯作者: Eisenberg, Dan

Interaction between increasing body mass index and spinal cord injury to the probability of developing a diagnosis of nonalcoholic fatty liver disease.

• DOI: 10.1002/osp4.643
• 发表时间: 2023-06
• 期刊: OBESITY SCIENCE & PRACTICE
• 影响因子: 2.2
• 作者: Eisenberg, Dan;Arnow, Katherine D.;Barreto, Nicolas B.;Davis, Kristen;LaVela, Sherri L.;Frayne, Susan M.;Nevedal, Andrea L.;Wu, Justina;Harris, Alex H. S.
• 通讯作者: Harris, Alex H. S.