Measuring the Longitudinal Relationshipsbetween Obesity, Weight Management Intervention, and Medical Expenditure

测量肥胖、体重管理干预和医疗支出之间的纵向关系

• 批准号: 10209965
• 负责人: MATTHEW L MACIEJEWSKI
• 金额: --
• 依托单位: DURHAM VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-06-01 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10209965
• 关键词: Address; Adoption; Adult; Affect; Algorithms; Behavior Therapy; Behavioral; Big Data; Body Weight decreased; Body mass index; Businesses; Caring; Characteristics; Clinical; Complement component C4; Coronary heart disease; Counseling; Data Sources; Degenerative polyarthritis; Disease; Economics; Effectiveness; Eligibility Determination; Expenditure; Goals; Health; Health Expenditures; Health Promotion; Healthcare; Hypertension; Individual; Informatics; Intervention; Lead; Life Style; Longitudinal trends; Measures; Medical; Morbid Obesity; Natural History; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Outcome; Overweight; Patient-Centered Care; Patients; Pattern; Pharmacotherapy; Policy Analysis; Population; Prevalence; Research; Resources; Risk; Running; Strategic Planning; Subgroup; Systems Integration; Validation; Veterans; Weight; Weight Gain; Weight maintenance regimen; bariatric surgery; clinical risk; disorder prevention; economic evaluation; economic impact; economic outcome; experience; follow-up; improved; improved outcome; machine learning method; obese patients; obesity risk; obesity treatment; population based; population health; preventable death; programs; research clinical testing; symposium; treatment effect; trend; weight loss intervention

The prevalence of obesity among adults is stabilizing after decades of unrelenting increases and about 68% of Veterans are considered either overweight or obese. Obesity is the second leading cause of preventable deaths in the US and is associated with a wide range of diseases, such as hypertension, type 2 diabetes mellitus, coronary heart disease, and osteoarthritis. These clinical risks lead obese patients to incur disproportionately high health expenditures. In 2008, annual health expenditures attributable to obesity were estimated to be $147 billion, concentrated among morbidly obese patients. In 2013, 28.2% of overall health expenditures for adults was incurred for obesity-associated care. Currently, three types of weight management interventions are available to overweight and obese VA patients: behavioral lifestyle counseling, pharmacotherapy and bariatric surgery. The most widely used of these interventions is behavioral counseling through the MOVE! program. Despite the widespread adoption of MOVE! as a first line treatment for obesity in VA, MOVE! participation has been associated with modest short- term weight loss and evidence is absent regarding the clinical and economic effectiveness of MOVE! beyond a 12-month follow-up. No prior VA studies have examined the natural history of weight gain, long-term expenditures of normal weight, overweight and obese Veterans, or changes in weight and expenditures attributable to MOVE!. It is important to understand longitudinal (20-year) patterns of VA healthcare expenditures by BMI progression to characterize the long-run scope of the problem of obesity in VA. Such results will then provide significant context for evaluating the health and economic effectiveness of MOVE! participation. Taken together, the four specific aims will enable an examination of impact of MOVE! on Veteran outcomes in the context of VA's overall population-level weight management strategy on eligible Veterans: Aim 1: Identify latent classes of different BMI progression trajectories between 2000-2019. Aim 2: Estimate differences in long term VA expenditures between latent BMI classes. Aim 3: Identify the average treatment effect of MOVE! and characteristics of Veterans who experience the greatest weight reductions following MOVE! participation. Aim 4: Identify the average treatment effect of MOVE! on expenditures and characteristics of Veterans who experience the greatest reduction in VA expenditures following MOVE! participation. Next Steps: The examination of 20-year expenditures associated with obesity and differential effects of MOVE! responds to one of the top four strategic goals identified in the VA FY 2018-2024 Strategic Plan by informing approaches to focus resources more efficiently. This study also addresses HSR&D's cross-cutting priority of business case and policy analysis and the Healthcare Informatics priority through the analysis, validation, and application of Big Data sources to improve individual and population health. This research will also enable us to formalize an algorithm to identify patients most likely to benefit from MOVE!, as well as those unlikely to achieve significant clinical weight loss through MOVE!. Following identification of Veterans at greatest risk for obesity and high VA expenditures, and of Veterans who experience the greatest weight and expenditure improvements following weight loss intervention, we will partner with NCP to determine how best to implement a prioritization strategy to develop need-tailored behavioral programs.

成年人中的肥胖率在经历了几十年的无情增长和大约 68%的退伍军人被认为超重或肥胖。肥胖是第二大诱因 在美国是可预防的死亡，与一系列疾病有关，如高血压、2型 糖尿病、冠心病和骨关节炎。这些临床风险导致肥胖患者 医疗支出高得不成比例。2008年，可归因于肥胖的年度医疗支出为 估计为1470亿美元，集中在病态肥胖患者中。2013年，占总体健康的28.2% 成年人的支出用于与肥胖相关的护理。 目前，有三种类型的体重管理干预措施可用于超重和肥胖退伍军人管理局 患者：行为生活方式咨询、药物治疗和减肥手术。使用最广泛的 这些干预措施都是通过行为咨询的方式进行的！程序。尽管广泛采用了 移动!作为退伍军人病区肥胖的一线治疗方法，行动起来！参与与适度的做空联系在一起- 关于MOVE的临床和经济效果，缺乏长期减肥和证据！超越了 随访12个月。此前没有退伍军人事务部的研究考察了体重增加的自然历史，长期 正常体重、超重和肥胖退伍军人的支出，或体重变化和支出 归因于搬家！了解退伍军人医疗保健的纵向(20年)模式非常重要 通过体重指数进展来表征退伍军人管理局肥胖问题的长期范围的支出。是这样的 结果将为评估MOVE的健康和经济效益提供重要的背景！ 参与。加在一起，这四个具体目标将使我们能够检查Move的影响！关于退伍军人 退伍军人管理局关于合格退伍军人的总体人口一级体重管理战略的成果： 目标1：确定2000-2019年不同BMI进展轨迹的潜在类别。 目标2：估计潜在BMI类别之间长期VA支出的差异。 目标3：确定MOVE的平均治疗效果！以及退伍军人的特点 搬家后最大的减重效果！参与。 目标4：确定MOVE的平均治疗效果！论退伍军人的消费支出及其特点 体验搬家后退伍军人管理局支出的最大降幅！参与。 下一步：检查20年来与肥胖相关的支出和不同的影响 移动!响应退伍军人事务部2018-2024财年战略计划中确定的四大战略目标之一 告知更有效地集中资源的方法。这项研究还涉及高铁与研发的交叉问题 通过分析业务案例和政策分析的优先级和医疗信息化的优先级， 验证和应用大数据来源，以改善个人和人口健康。这项研究将 还使我们能够将一个算法正式化，以确定最有可能从Move！中受益的患者以及 不太可能通过Move实现显著的临床减肥！在确认退伍军人身份后 肥胖和退伍军人支出高的风险最大，退伍军人的体重和 减肥干预后的支出改善，我们将与NCP合作确定如何最好地 实施优先战略，开发根据需要量身定制的行为计划。