Promoting Real World Implementation of an Evidence-Based Weight Management Intervention in Primary Care

促进初级保健中循证体重管理干预措施的实际实施

• 批准号: 10430043
• 负责人: Margaret B Conroy
• 金额: $ 61.12万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10430043
• 关键词: Behavior Therapy; Body Weight; Body Weight Changes; Body Weight decreased; Caring; Chronic; Chronic Care; Clinic; Clinical; Cost Measures; Development; Diet; Effectiveness of Interventions; Electronic Health Record; Fostering; Future; Health; Healthcare; Healthcare Systems; Individual; Information Systems; Insurance Carriers; Intervention; Life Style; Maintenance; Medical; Medical Care Team; Medicare/Medicaid; Modeling; Nurses; Obesity; Participant; Patients; Persons; Phase; Physical activity; Pragmatic clinical trial; Primary Health Care; Protocols documentation; Provider; Publishing; Randomized; Randomized Clinical Trials; Research Project Grants; Research Support; Resources; Services; Site; System; Technology; Testing; Training; United States; Universities; Update; Utah; Weight; Weight maintenance regimen; Work; base; cost; dashboard; design; diabetes risk; disorder later incidence prevention; effectiveness evaluation; evidence base; experience; follow-up; health care settings; health information technology; implementation design; innovation; intervention delivery; intervention mapping; nutrition; obesity treatment; patient population; patient portal; post implementation; primary outcome; programs; success; tool; weight maintenance

ABSTRACT Obesity is a major health problem in the United States and associated with increased risk of diabetes. There is a great need for interventions that can assist with long-term maintenance of healthy body weight and be sustainably integrated into existing health care teams. We have developed and tested an innovative weight loss maintenance intervention – Maintaining Activity and Nutrition through Technology-Assisted Innovation in Primary Care (MAINTAIN-pc) – delivered through the electronic health record (EHR) to help patients maintain recent intentional weight loss and successful lifestyle strategies. We have conducted and published results from a randomized clinical trial of MAINTAIN-pc at the University of Pittsburgh and found that participants who received EHR tracking tools and personalized coaching had significantly lower weight regain at 24 months (primary outcome) than participants who received EHR tracking tools alone. MAINTAIN-pc leveraged commonly available health information technology (HIT) tools to track participant progress and support patients and their providers in ongoing efforts to maintain weight loss. Despite the success of MAINTAIN-pc, two key questions about the practicality and sustainability of this intervention remain unanswered: (i) whether the HIT could be adapted at other sites and (ii) whether coaching could be delivered leveraging existing staff resources rather than interventionists supported by a research grant. We propose a pragmatic clinical trial to test the implementation and impact of the MAINTAIN-pc protocol in routine healthcare settings: MAINTAIN PRIME (Promoting Real (World) IMplEmentation). MAINTAIN PRIME will be conducted in 14 primary care practices affiliated with the University of Utah and will capitalize on further advances in HIT (e.g., dashboards to track patient populations) and team-based care models to deliver the intervention with minimal support from research staff. MAINTAIN PRIME will measure costs to inform future sustainability, and it will study workflow and individual, clinical, and organizational attributes to determine facilitators and barriers to successful implementation. Our proposed project will include three phases: 1) pre-implementation, in which we will do collaborative implementation design with clinic and IT teams and vanguard implementation mapping; 2) implementation, in which we will conduct a pragmatic clinical trial with weight change at 24 months as the primary outcome; and 3) post-implementation, in which we will evaluate the success of MAINTAIN PRIME, including barriers, facilitators, and costs that will inform future sustainability and be summarized in a “toolkit” to foster dissemination. By focusing on weight maintenance and relapse prevention, increased use of existing staff, and integration with HIT systems and tools, we will fill a crucial gap in the long-term treatment of obesity as a chronic medical condition.

抽象的 肥胖是美国的一个主要健康问题，与糖尿病风险增加有关。有 非常需要能够帮助长期维持健康体重的干预措施 可持续地融入现有的医疗保健团队。我们开发并测试了一种创新的重量 损失维持干预——通过技术辅助创新维持活动和营养 初级保健 (MAINTAIN-pc) – 通过电子健康记录 (EHR) 提供，帮助患者维持健康 最近有意减肥和成功的生活方式策略。我们已经进行并公布了结果 匹兹堡大学的一项 MAINTAIN-pc 随机临床试验发现，参与者 接受 EHR 跟踪工具和个性化指导的患者在 24 个月时体重反弹显着降低 （主要结果）与仅接受 EHR 跟踪工具的参与者相比。 MAINTAIN-pc杠杆 用于跟踪参与者进展并支持患者的常用健康信息技术 (HIT) 工具 及其提供者不断努力维持减肥。尽管 MAINTAIN-pc 取得了成功，但有两个关键 关于这一干预措施的实用性和可持续性的问题仍未得到解答：(i) 是否 HIT 可以在其他地点进行调整，以及 (ii) 是否可以利用 现有的人力资源，而不是由研究补助金支持的干预专家。我们提出一个 务实的临床试验，测试 MAINTAIN-pc 协议在常规医疗保健中的实施和影响 设置：MAINTAIN PRIME（促进真实（世界）实施）。 MAINTAIN PRIME 将在 犹他大学附属的 14 个初级保健机构将利用 HIT 的进一步进步 （例如，跟踪患者群体的仪表板）和基于团队的护理模型来提供干预措施 研究人员的支持最少。 MAINTAIN PRIME 将衡量成本以告知未来的可持续发展，并且 将研究工作流程以及个人、临床和组织属性，以确定促进和障碍 成功实施。我们提议的项目将包括三个阶段：1）预实施，其中我们 将与诊所和 IT 团队进行协作实施设计以及先锋实施规划； 2） 实施中，我们将进行一项务实的临床试验，以24个月时的体重变化为标准 主要结果； 3) 实施后，我们将评估 MAINTAIN PRIME 的成功， 包括障碍、促进因素和成本，这些因素将为未来的可持续性提供信息，并总结在“工具包”中，以便 促进传播。通过关注体重维持和预防复发，增加现有药物的使用 人员，以及与 HIT 系统和工具的集成，我们将填补肥胖长期治疗的关键空白 作为一种慢性疾病。