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

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。

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.