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Managing Obesity by Leveraging Health Information Technology to Lower Cancer Risk

利用健康信息技术控制肥胖以降低癌症风险

基本信息

批准号：
10551269
负责人：
KAREN C JOHNSON
金额：
$ 62.63万
依托单位：
UNIVERSITY OF TENNESSEE HEALTH SCI CTR
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-01-14 至 2026-12-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10551269
关键词：
Address Adult Affect Area Behavior Therapy Behavioral Body Weight Changes Body Weight decreased Clinical Practice Guideline Clinical Trials Collaborations Communities Diabetes Mellitus Diet Disease Effectiveness Electronic Health Record Enrollment Funding Goals Group Practice Guidelines Health Health Personnel Health Sciences Healthcare Systems Incidence Intervention Intervention Studies Low income Malignant Neoplasms Managed Care Medical Methodist Church Methods Minority Groups Modeling Obesity Obesity associated cancer Outcome Overweight Participant Patients Persons Physical activity Physicians Population Population Group Private Sector Protocols documentation Public Sector Randomized Recommendation Research Research Personnel Research Project Grants Research Proposals Resources Risk Risk Factors Risk Reduction Rural Population Site Support System System Target Populations Technology Telephone Tennessee Testing Time Touch sensation Training Translating Underserved Population United States United States National Institutes of Health Universities Weight Gain Weight maintenance regimen Work adult obesity behavior change cancer risk cancer type clinical practice comparison group comparison intervention cost effective ethnic minority ethnic minority population formative assessment group intervention health care availability health information technology health plan healthy lifestyle high risk innovation intervention refinement lifestyle intervention low socioeconomic status minority health minority health disparity obesity management obesity risk obesity treatment patient health information patient portal prevent primary care setting primary outcome racial minority racial minority population randomized, clinical trials rural area rural setting social social health determinants socioeconomics success tool uptake urban area urban setting weight loss intervention weight loss program

项目摘要

Obesity is an important risk factor for many serious diseases including many types of cancer.2-36 In the United States, obesity disproportionally affects underserved population groups such as racial and ethnic minorities, persons with lower socioeconomic status, and persons living in rural areas.1,37,38 These underserved groups are also at increased risk for developing and dying from cancer.39-42 Large clinical trials, such as Look AHEAD (Action for Health in Diabetes), have shown that a multicomponent weight loss intervention combining diet, physical activity, and behavioral modification is effective in achieving long term weight loss which resulted in a lower incidence of obesity-related cancers.43-45 As a result, clinical practice guidelines recommend the delivery of obesity interventions in primary care settings. However, it is unknown if such weight loss interventions work well in underserved populations or in rural settings because of limited access to healthcare resources and community facilities for a healthy lifestyle and/or because the target population may have different cultural and social backgrounds. To overcome these specific barriers to implementing a weight loss intervention, we propose a practice- based clinical trial to translate the efficacious Look AHEAD Intensive Lifestyle Intervention (ILI) to underserved populations. In this project, we will modify the intervention to be delivered through Health IT specifically the patient portal in the electronic health record (EHR) and will work with the Methodist Medical Group to establish partnerships between the investigators and community stakeholders. This project tests whether the Look AHEAD Intensive Lifestyle Intervention (ILI) will result in significant weight loss when delivered through Health IT- EHR patient portal compared to a Comparison intervention. This project will be conducted in 2 stages: a formative assessment stage (Stage 1) and a clinical trial stage (Stage 2). During Stage 1, we will modify the interactive technology-based Look AHEAD ILI that we already developed for the TARGIT study (Active Intervention Group). We will also adapt the Look AHEAD Comparison condition (DSE group) for our Comparison condition.56 We will also optimize the protocol for acceptability in underserved populations and in a rural setting. During Stage 2, we will randomly assign 250 participants to either the Comparison Group or the Active Intervention Group to address the primary aim of testing the hypothesis that a multicomponent, behavioral weight loss intervention delivered through Health IT – EHR patient portal will lead to significantly greater weight loss 12 months after enrollment compared with a comparison group. Our Health IT-based intervention is potentially cost-effective and thus disseminable to any practice-based physician group with access to an EHR with a patient portal. We have chosen the Socio-ecological Model as our conceptual model to assist with understanding social determinants of health as related to the study intervention and weight loss.

肥胖是许多严重疾病的重要危险因素，包括许多类型的癌症。在美国，肥胖不成比例地影响着服务不足的人口群体，如种族和民族少数群体、社会经济地位较低的人和生活在农村地区的人。群体患癌症和死于癌症的风险也在增加。39-42项大型临床试验，如LOOK AHEAD(糖尿病健康行动)的研究表明，多组分的减肥干预结合了饮食、体力活动和行为调整在实现长期减肥方面是有效的，这导致了 43-45因此，临床实践指南建议在初级保健环境中提供肥胖干预措施。然而，目前还不清楚这样的减肥是否由于获得医疗保健的机会有限，干预措施在服务不足的人群或农村环境中效果良好健康生活方式的资源和社区设施和/或因为目标人群可能有不同的文化和社会背景。为了克服实施减肥干预的这些具体障碍，我们建议采取以下做法：基于临床试验将有效的前瞻性强化生活方式干预(ILI)转化为服务不足人口。在此项目中，我们将修改通过Health IT提供的干预措施，特别是电子健康记录(EHR)中的患者门户，并将与卫理公会医疗集团合作在调查人员和社区利益攸关方之间建立伙伴关系。此项目测试是否展望未来，强化生活方式干预(ILI)将导致显著减肥时，通过健康IT-EHR患者门户与对照干预的比较。这个项目将在2个月内进行阶段：形成评估阶段(阶段1)和临床试验阶段(阶段2)。在第一阶段，我们将修改我们已经为TARGIT研究开发的基于交互技术的前瞻ILI (积极干预组)。我们还将调整前瞻性比较条件(DSE组)以比较条件。56我们还将优化议定书，使之在服务不足的人群和在乡村环境。在第二阶段，我们将随机将250名参与者分配到比较组或积极干预小组，以解决检验假设的主要目标，通过Health IT-EHR患者门户提供的行为减肥干预将显著与对照组相比，注册后12个月的体重减轻幅度更大。我们的医疗保健以IT为基础干预可能具有成本效益，因此可以传播到任何以执业为基础的医生群体，通过患者门户访问电子病历。我们选择了社会生态模型作为我们的概念模型帮助理解与研究干预和减肥相关的健康的社会决定因素。