Use of Electronic Health Records for Addressing Overweight and Obesity in Primary

描述(申请人提供)：超重和肥胖是非常重要的临床和公共卫生问题。超过三分之一的美国成年人肥胖，另有三分之一超重。超重和肥胖与多种疾病和不良健康结局的风险增加有关，包括糖尿病、心血管疾病、高血压、某些癌症、残疾和全因死亡。美国国立卫生研究院(NIH)和其他组织已经发布了关于成人超重和肥胖的识别、评估和治疗的循证指南，但许多研究表明，初级保健临床医生通常不记录超重或肥胖或与患者讨论体重管理。电子健康记录通过提供提醒和临床决策支持等工具，有可能改善临床医生对超重和肥胖的诊断和治疗。然而，很少有基于EHR的工具被开发来解决成年人的超重和肥胖问题。此外，允许患者查看并与其EHR互动的个人健康记录(PHR)可能能够通过协助自我监控和提供量身定制的信息和反馈来帮助患者管理体重，但其用途尚未深入探讨。拟议研究的目标是开发和评估基于EHR和PHR的工具，以改进初级保健环境中超重和肥胖的诊断和治疗，并最终减少超重和肥胖患者的体重增加。具体目标是：1)开发基于电子健康记录的工具，帮助初级保健临床医生识别、评估和治疗超重或肥胖患者；2)进行随机对照试验，评估基于电子健康记录的工具在初级保健中识别、评估和治疗超重和肥胖的有效性；以及3)开发基于个人健康记录的工具，帮助患者控制体重。这项研究将在布里格姆妇女医院的18个初级保健诊所内进行，这些医院已经有EHR和PHR。这项研究可能会对初级保健环境中超重和肥胖的管理产生重要影响。为临床医生提供的基于EHR的提醒、警报和决策支持，以及为患者提供的基于PHR的体重管理工具，有可能以广泛和经济高效的方式解决超重和肥胖问题，使其成为有吸引力的公共卫生战略。在布里格姆妇女医院的初级保健实践中进行这项研究，将使我们能够评估这些工具在现实世界中的可行性和有效性。

DESCRIPTION (provided by applicant): Overweight and obesity are highly significant clinical and public health issues. More than one third of U.S. adults are obese and another third are overweight. Overweight and obesity are associated with increased risk of numerous diseases and poor health outcomes, including diabetes, cardiovascular disease, hypertension, certain cancers, disability, and all-cause mortality. The National Institutes of Health (NIH) and other organizations have published evidence-based guidelines on the identification, evaluation, and treatment of overweight and obesity in adults, but many studies show that primary care clinicians often do not document overweight or obesity or discuss weight management with their patients. Electronic health records (EHRs) have the potential to improve clinicians' diagnosis and treatment of overweight and obesity by providing tools such as reminders and clinical decision support. However, very few EHR-based tools have been developed to address overweight and obesity in adults. In addition, personal health records (PHRs) that allow patients to view and interact with their EHRs may be able to help patients with weight management by assisting with self- monitoring and providing tailored information and feedback, but their use for this purpose has not been explored in depth. The objectives of the proposed research are to develop and evaluate EHR- and PHR-based tools to improve diagnosis and treatment of overweight and obesity in the primary care setting and, ultimately, to reduce weight gain in overweight and obese patients. The specific aims are: 1) to develop EHR-based tools to help primary care clinicians identify, evaluate, and treat patients who are overweight or obese; 2) to conduct a randomized controlled trial to assess the effectiveness of EHR-based tools for the identification, evaluation, and treatment of overweight and obesity in primary care; and 3) to develop PHR-based tools to help patients manage their weight. This research will be conducted within 18 primary care practices at Brigham and Women's Hospital that already have an existing EHR and PHR. This research could have an important impact on the management of overweight and obesity in the primary care setting. EHR-based reminders, alerts, and decision support for clinicians and PHR-based weight management tools for patients have the potential to address overweight and obesity in a broad-reaching and cost-effective manner, making them attractive public health strategies. Conducting this research within primary care practices at Brigham and Women's Hospital will enable us to evaluate the feasibility and effectiveness of such tools in a real-world setting.