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

• 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
• 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

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一个重要危险因素，包括许多类型的癌症。 在美国，肥胖症会严重影响服务不足的人群，如种族和民族 少数民族、社会经济地位较低的人和生活在农村地区的人。 这些群体患癌症和死于癌症的风险也在增加。39 - 42大型临床试验，如Look AHEAD（糖尿病健康行动）已经表明，多组分减肥干预结合 饮食、体育活动和行为改变对实现长期减肥有效， 肥胖相关癌症的发病率较低。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，目前尚不清楚这种减肥 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 资源和社区设施的健康生活方式和/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，我们提出了一种做法- 基于临床试验，将有效的前瞻性强化生活方式干预（ILI）转化为服务不足的 人口。在本项目中，我们将修改通过健康IT提供的干预措施，特别是 电子健康记录（EHR）中的患者门户网站，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。该项目测试了 展望未来强化生活方式干预（ILI）将导致显着的体重减轻时，通过交付 健康IT-EHR患者门户与比较干预的比较。该项目将在2 阶段：形成性评估阶段（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式技术的Look AHEAD ILI （积极干预组）。我们还将调整前瞻比较条件（DSE组）， 比较条件。56我们还将优化该方案，以便在服务不足的人群和 农村设置。在第二阶段，我们将随机分配250名参与者到比较组或 积极干预组，以解决测试的假设，一个多组分， 通过健康信息技术-EHR患者门户网站提供的行为减肥干预将导致显著 与对照组相比，入组后12个月的体重减轻更大。我们的健康IT 干预具有潜在的成本效益，因此可以传播到任何基于实践的医生群体， 通过患者门户访问EHR。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体重减轻相关的健康社会决定因素。