Socioecological Factors Associated with Ethnic Disparities in Bariatric Surgery Utilization - Diversity Supplement R01MD011686

与减肥手术利用中的种族差异相关的社会生态因素 - 多样性补充资料 R01MD011686

• 批准号: 10538488
• 负责人: Sarah Elizabeth Messiah
• 金额: $ 9.75万
• 依托单位: UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-16 至 2024-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10538488
• 关键词: Black Populations; Body Weight; Body Weight decreased; COVID-19; COVID-19 pandemic; Caring; Characteristics; Clinical; Dissemination and Implementation; Environmental Risk Factor; Ethnic Origin; Ethnic group; Future; Goals; Heart Diseases; Hispanic Populations; Hospitalization; Hospitals; Individual; Interview; Maintenance; Malignant Neoplasms; Mediating; Medical; Metabolic; Modeling; Morbid Obesity; Motivation; Non-Insulin-Dependent Diabetes Mellitus; Not Hispanic or Latino; Operative Surgical Procedures; Outcome; Parents; Patients; Persons; Postoperative Care; Postoperative Period; Procedures; Provider; Resolution; SARS-CoV-2 transmission; Schedule; Surveys; Telemedicine; Time; United States; Visit; asynchronous communication; bariatric surgery; care delivery; comorbidity; effective therapy; ethnic disparity; experience; health care availability; improved; interest; parent grant; risk mitigation; satisfaction; telehealth; treatment choice

Metabolic and bariatric surgery (MBS) is a safe and medically effective treatment choice for severe obesity. Yet, despite (1) an increase in the number of MBS procedures performed in the United States annually, and (2) the fact that many express interest in MBS, only about 50% of referred or eligible persons for MBS complete the procedure. Furthermore, studies have documented Hispanics and non-Hispanic Blacks (NHB) are significantly less likely than non-Hispanic Whites (NHW) to complete MBS despite higher rates of both severe obesity and obesity-related comorbidities (e.g. type 2 diabetes, heart disease, cancer). Reasons for the ethnic group disparities in post-MBS weight loss and comorbidity resolution are largely unknown. The recent COVID-19 pandemic added greater complexity to this challenge as hospitals repeatedly cancelled elective surgeries, including MBS, to accommodate anticipated surges in COVID-19-related hospitalizations. Additionally, a significant portion of pre- and post-MBS care has moved to a telehealth model. Post-MBS patients may not be comfortable with, have the means or desire to attend in-person visits due to continued COVID-19 concerns. Beyond risk mitigation for transmission of COVID-19, telehealth for post-MBS patients may improve healthcare access for those who have limited mobility or are housebound; however, more information is needed on what these patients value from in-person visits to make telehealth more acceptable and effective. Future studies should identify individual and environmental factors, including patient motivation to use this platform of care delivery, and evaluate whether these factors are correlated with the type of provider interface used (e.g. video, audio-only, and real-time vs. asynchronous communication) and body weight outcomes. In addition, weight loss maintenance and patient experience/satisfaction with the different models of delivery should also be explored. The goal of this supplement is to enhance our current parent study survey battery with dissemination and implementation (D & I) qualitative interviews, specifically related to post-operative care delivered via telehealth in a subsample (n=40) of our MBS completers (n=200). The proposed study will focus on how patient telemedicine D & I metrics (e.g. acceptability, feasibility) differ by ethnic group. This project is within the scope of the parent grant (patient-provider relationships is one of our battery sub-domains) and enhances our ability to achieve the approved aims: (AIM 1) Identify the socioecological characteristics associated with the following four patient-determined MBS groups: (1) early-completers of MBS (< 3 months), (2) later-completers of MBS (>3 months but within 12-15 months), (3) non-completers of MBS because surgery was electively cancelled after being scheduled; and (4) non-completers due to no interest in MBS after receiving a medical referral (AIM 2) Determine how differences in Groups 1 and 2 relate to post-operative weight loss and comorbidity resolution at 6- 12- and 24-months post-MBS; and (AIM 3) Explore the mediating and moderating effects of ethnicity, intrapersonal, interpersonal, clinical and other environmental interactions on MBS completer group differences.

代谢和减肥手术(MBS)是治疗严重肥胖症的安全和有效的医学选择。然而， 尽管(1)美国每年进行的住房抵押贷款证券化程序的数量有所增加，以及(2) 虽然很多人对按揭证券表示有兴趣，但只有约50%获转介或合资格申请按揭证券的人士完成 程序。此外，研究还记录了西班牙裔和非西班牙裔黑人(NHB)的显著差异 与非西班牙裔白人(NHW)相比，完成MBS的可能性更低，尽管严重肥胖率和 与肥胖相关的合并症(如2型糖尿病、心脏病、癌症)。种族群体的原因 MBS后体重减轻和合并症解决方面的差异在很大程度上是未知的。最近的新冠肺炎 大流行增加了这一挑战的复杂性，因为医院一再取消选择性手术， 包括MBS，以适应预期的新冠肺炎相关住院人数激增。此外，一个 相当大一部分MBS前和MBS后的护理已经转向远程医疗模式。MBS后的患者可能不会 由于对新冠肺炎的持续担忧，愿意、有办法或希望参加面对面的访问。 除了降低新冠肺炎传播的风险外，为后MBS患者提供远程医疗可能会改善医疗保健 为行动不便或呆在家里的人提供访问权限；但是，需要了解更多有关 这些患者重视面对面的访问，以使远程医疗更容易接受和更有效。未来研究 应确定个人和环境因素，包括患者使用此护理平台的动机 并评估这些因素是否与所使用的提供商接口的类型相关(例如视频， 纯音频、实时与异步通信)和体重结果。此外，减肥 还应探讨不同交付模式的维护和患者体验/满意度。 本附录的目的是通过传播和传播来加强我们当前的家长研究调查单元 实施(D&I)定性访谈，具体涉及通过远程保健提供的术后护理 在我们的MBS完成者的一个子样本(n=40)中(n=200)。拟议的研究将侧重于患者 远程医疗D&I指标(如可接受性、可行性)因种族群体而异。此项目在范围内 家长补助金(患者-提供者关系是我们的电池子域之一)，并增强我们的能力 实现核准的目标：(目标1)确定与以下四项有关的社会生态特征 患者决定的MBS组：(1)MBS早期完成者(3个月)，(2)MBS后期完成者(&gt；3 月但在12-15个月内)，(3)住房抵押贷款证券化的非完成者，因为手术在以下时间被选择性取消 (4)在接受医疗转介后因对按揭证券不感兴趣而未能完成(AIM 2) 确定第1组和第2组的差异如何与术后体重减轻和合并症解决有关 6-12个月和24个月后的住房抵押贷款；和(目标3)探讨族裔的调解和调节作用， 个人内部、人际、临床和其他环境交互作用对MBS完成者群体差异的影响。