PATHWEIGH: pragmatic weight management in primary care

项目摘要/摘要 肥胖症--及其许多并存的疾病--现在已经超过吸烟，成为可预防的主要原因。 美国的死亡案例。尽管肥胖是可以治疗和预防的，但治疗 合并症，而不是肥胖本身，仍然是治疗的主体。重要的是，肥胖症 越来越多的人认识到，这不仅是疾病的风险因素，而且本身也是一种疾病。尽管如此，1%的 任何程度超重或肥胖的人都可以得到除了生活方式建议之外的任何建议。原因： 缺乏体重管理的优先顺序是广泛和复杂的。实际上，主要的利益相关者， 包括肥胖者、他们的临床医生和保险公司在内的人都屈服于这种流行病。因此，有一个 迫切需要用务实的方法和证据系统地解决这些不同的障碍 促进了体重管理的实践。为了解决这一差距，科罗拉多大学健康家庭 科罗拉多州威斯敏斯特的医学诊所开发了PATHWEIGH。PATHWEIGH优先排序权重 初级保健的管理方式：1)使用EPIC中内置的指定、省时的流程图(最 (美国广泛使用的电子病历(EMR)系统)它引导和捕捉周围的历史 体重增加和减肥建议，以及与诊断和账单有关的实际问题， 2)临床医生和团队的培训，a)使用PATHWEIGH作为工具，b)关于当前有效的教育 体重管理的实践。我们的初步研究证明了有效实施 初级保健诊所的PATHWEIGH导致18岁以上患者体重减轻显著改善 月份。拟议工作的总体目标是测试PATHWEIGH与标准的 在57个初级保健诊所提供护理，这些诊所跨越不同的环境、患者群体和社区背景 以审查优化执行情况的方法。我们的具体目标包括：1)评估执行情况 PATHWEIGH的有效性，并与使用标准护理(SOC)的对照诊所进行比较 体重在6个月内减轻(主要)，在12个月和18个月内保持减肥(次要)- 在初级保健中按优先顺序就诊，2)确定患者减肥和减肥维持的预测因素 使用调解人和调解人分析，包括相关患者、提供者和临床层面的变量，以及3) 审查影响PATHWEIGH采用、实施和可持续性的背景因素 实用、稳健、实施和可持续发展模式(PRISM)。为了实现这些目标，我们将 采用阶梯式楔形整群随机试验。数据收集和分析方法包括临床数据， 使用统计、定性和混合方法进行调查、观察和访谈。PATHWEIGH拥有 有可能成为一种可扩展的、低成本的、务实的肥胖方法。建议的理由是 研究表明，PATHWEIGH的最终成功依赖于了解如何实施证据- 以体重管理干预措施为基础，使其在实践中最有效、最有效和最有效地使用和维护。

Project Summary/Abstract Obesity – with its many comorbid conditions – has now surpassed smoking as the leading cause of preventable death in the United States. Despite the fact that obesity is both treatable and preventable, treating the comorbidities, rather than obesity per se remains the mainstay of therapy. Importantly, obesity is being increasingly recognized not only as a risk factor for disease, but a disease unto itself. Despite this fact, <1% of people with any degree of overweight or obesity are offered anything other than lifestyle advice. Reasons for lack of weight management prioritization are extensive and complex. Effectively, the major stakeholders, including people with obesity, their clinicians and insurers, have yielded to the epidemic. Thus, there is a critical need to systematically address these diverse barriers with pragmatic approaches and evidence that facilitates the practice of weight management. To address this gap, the University of Colorado Health Family Medicine clinic in Westminster, Colorado developed PATHWEIGH. PATHWEIGH prioritizes weight management in primary care by: 1) using a designated, time-efficient flowsheet built into EPIC (the most widely utilized electronic medical record (EMR) system in the U.S.) that guides and captures history around weight gain and recommendations for weight loss, as well as practical issues related to diagnosis and billing, and 2) clinician and team training on a) use of PATHWEIGH as a tool, and b) education on current effective practices for weight management. Our pilot study demonstrated the ability to effectively implement PATHWEIGH in a primary care clinic that lead to significant improvement in patient weight loss over 18 months. The overall objective for the proposed work is to test the effectiveness of PATHWEIGH vs. standard of care in 57 primary care clinics that span diverse settings, patient populations and community contexts, as well as to examine methods to optimize implementation. Our specific aims include: 1) Evaluate the implementation of PATHWEIGH and determine its effectiveness versus control clinics using standard of care (SOC) on patient weight loss at 6 months (primary) and weight loss maintenance at 12 and 18 months (secondary) for weight- prioritized visits in primary care, 2) Identify predictors of patient weight loss and weight loss maintenance using mediator and moderator analysis, including relevant patient, provider and clinic-level variables, and 3) Examine contextual factors affecting the adoption, implementation and sustainability of PATHWEIGH using the Practical, Robust, Implementation and Sustainability Model (PRISM). To complete these aims, we will utilize a stepped wedge cluster randomized trial. Data collection and analysis methods include clinical data, surveys, observations and interviews using statistical, qualitative and mixed methods. PATHWEIGH has the potential to be a scalable, low-cost, pragmatic approach to obesity. The rationale that underlies the proposed research is that the ultimate success of PATHWEIGH relies on understanding how to implement evidence- based weight management interventions and make them most effective, used and maintained in practice.