RCT of Video-Conference & In-Person Weight Loss Services for Adult CHC Patients

视频会议RCT

• 批准号: 8296145
• 负责人: DANIEL O CLARK
• 金额: $ 58.69万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-04-03 至 2016-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8296145
• 关键词: Adult; Behavior; Behavior Therapy; Blood Pressure; Body Weight decreased; Body mass index; Caring; Community Health Centers; Congresses; Control Groups; Country; Disease; Energy Intake; Energy Metabolism; Exercise; Foundations; Group Meetings; Health; Health Care Costs; Health Care Reform; Health system; Holly; Home environment; Image; Institute of Medicine (U.S.); Interactive Communication; Internet; Intervention; Lead; Location; Low Income Population; Medical; Methods; Modeling; Monitor; Obesity; Outcome; Participant; Patients; Persons; Physical activity; Population; Populations at Risk; Primary Health Care; Process; Protocols documentation; Public Health; Public Hospitals; Randomized; Reporting; Research; Research Priority; Resources; Risk; Sampling; Self Efficacy; Services; Social Network; Social support; Solutions; Speed; Support Groups; System; Testing; Text; Time; Training; Transportation; Transportation of Patients; Travel; United States National Institutes of Health; Work; Writing; active method; arm; base; clinically significant; comparative effectiveness; cost; cost effective; cost effectiveness; design; editorial; effectiveness research; efficacy trial; ethnic minority population; health related quality of life; high risk; improved; intervention program; literacy; meetings; middle age; new technology; nutrition; nutrition education; obesity treatment; opportunity cost; population based; programs; safety net; skills; social cognitive theory; sound; symposium; three-arm study; treatment as usual; urban area; waist circumference; weight loss intervention

DESCRIPTION (provided by applicant): The Institute of Medicine gives top priority to identifying effective methods of treating obesity in at-risk populations such as the urban poor. Community health centers (CHC) provide primary care to persons regardless of ability to pay and under health care reform will be providing care to a large proportion of urban poor. To date, the most effective weight loss interventions have had frequent staff-patient interactions, high attendance, and physical activity. Such intensive interventions are a challenge for CHCs because they are chronically short staffed and have limited space. And, CHC patients often have limited transportation. Video-conferencing requires very little CHC space, and may reduce staff time and patient transportation needs. A single staff person can lead meeting sessions for patients located virtually anywhere. Although building an intervention for lower income populations based on broadband Internet may seem counterintuitive, broadband is available in most all urban areas. Additionally, on March 17, 2010, the FCC delivered a 10-year National Broadband Plan to Congress to bring high-speed Internet to 90% of U.S. homes. We have successfully piloted a multiparty video-conference weight loss program delivered to CHC patients in their homes using simple hardware and Internet access supplied by the project. We have used an exercise protocol tailored to obese CHC patients and well-established nutrition education and support materials modified for a participant population that includes persons with low literacy and numeracy skills. For the proposed efficacy trial we will randomize 150 adult CHC patients with body-mass index e30 and <50 to either an in-person weight loss program, a video-conference delivered weight loss program, or to a usual care control group. We hypothesize that, compared to usual care, 30% more persons in each of the active arms will have a clinically significant weight loss (e2 kg) at 6-months, and will maintain this weight loss a 12-months. Attendance and intervention costs will be compared between intervention arms and cost-effectiveness will be estimated for all three study arms. This work could result in an effective and accessible weight loss intervention that could be widely and rapidly disseminated through CHCs and broadband Internet. PUBLIC HEALTH RELEVANCE: This project will test whether twice-weekly weight loss classes delivered either in-person or via video-conference lead to greater weight loss than usual care. Participants will be obese, middle-aged patients of community health centers. Classes consist of progressive exercise and nutrition education designed for a population with a range of literacy and numeracy skills.

描述(由申请人提供)：医学研究所将确定有效的方法来治疗城市贫困人群等高危人群的肥胖症作为首要任务。社区卫生中心(CHC)为有支付能力的人提供初级保健，在医疗保健改革下，将向很大比例的城市贫困人口提供保健。到目前为止，最有效的减肥干预措施包括频繁的工作人员-患者互动、高出勤率和体力活动。这种密集的干预措施对社区卫生保健中心来说是一项挑战，因为它们长期人手不足，空间有限。而且，慢性丙型肝炎患者的交通往往有限。视频会议只需要很少的CHC空间，而且可能会减少工作人员的时间和病人的交通需求。一名工作人员就可以领导几乎位于任何地方的患者的会议。尽管基于宽带互联网为低收入人群建立干预措施似乎有违常理，但几乎所有城市地区都可以使用宽带。此外，2010年3月17日，FCC向国会提交了一份10年国家宽带计划，将高速互联网普及到90%的美国家庭。我们已经成功地试行了一个多方视频会议减肥计划，使用该项目提供的简单硬件和互联网接入，就可以在家中为CHC患者提供减肥服务。我们使用了为肥胖的CHC患者量身定做的锻炼方案，以及为包括低识字率和算术技能的参与者群体修改的完善的营养教育和支持材料。在拟议的疗效试验中，我们将150名体重指数为E30和50的成年CHC患者随机分为面对面减肥计划、视频会议减肥计划或常规护理对照组。我们假设，与常规护理相比，每个活动组的患者在6个月后临床显著体重下降(e2公斤)的人数增加30%，并将在12个月内保持这种体重下降。将比较干预单位之间的出席率和干预费用，并估计所有三个研究单位的成本效益。这项工作可以产生一种有效和可获得的减肥干预措施，可以通过社区保健中心和宽带互联网广泛和迅速地传播。 与公共健康相关：这个项目将测试每周两次的减肥课程，无论是亲自授课还是通过视频会议授课，是否会比通常的护理带来更大的减肥效果。参与者将是社区卫生中心的肥胖中年患者。课程包括为具有一系列识字和计算技能的人群设计的渐进式运动和营养教育。