Maintaining Activity and Nutrition through Technology-Assisted Innovation in Prim

描述（由申请人提供）：肥胖是美国一个主要且日益严重的健康问题。虽然许多干预措施已经导致短期体重减轻，但很少有方案支持成功维持健康的体重，更少的是推广到初级保健人群。肥胖往往是一种慢性、终生的疾病，在减肥后复发是很常见的。尽管肥胖与许多医学疾病有关，但体重干预通常是在真空中进行的，脱离了参与者通常的医疗保健，也没有初级保健团队的参与。因此，非常需要采取干预措施，帮助一般人群和有现有医疗条件的人长期保持健康的体重。此外，这种努力应与正在进行的医疗保健联系起来。我们的研究小组开发了一种干预手段——虚拟生活方式管理（VLM），成功地利用健康信息技术（HIT）促进初级保健患者减肥。我们现在建议将我们的工作扩展到评估HIT工具，这些工具旨在促进体重维持并防止成功减肥的初级保健患者复发。我们的建议利用了医疗信息技术的最新发展，例如在线访问和电子健康记录，这使初级保健站点能够联系患者并跟踪他们在持续减肥努力中的进展。我们提出了一项随机临床试验-通过技术辅助创新在初级保健中维持活动和营养(maintenance - pc) -来测试在线跟踪工具和患者体重维持“指导”访问以及初级保健提供者（pcp）的“实时”电子进度报告[持续指导（CC）]是否比单独使用在线跟踪工具[仅跟踪（to）]更成功地支持体重维持在一组体重下降5%的初级保健患者中他们的体重。参与者的在线辅导访问将通过初级保健网站的电子患者门户网站（HealthTrak）提供，而pcp的电子进度报告将通过电子健康记录（EHR）提供。我们提出的干预措施具有完善的理论框架，结合了慢性护理模式和与成功的行为减肥计划相关的原则：自我监控、支持、问题解决和复发预防。通过关注体重维持和复发预防，加强与初级保健的合作，以及与现有HIT系统和工具的整合，我们将扩展我们以前的工作，并填补成功治疗肥胖这一慢性疾病的关键空白。

DESCRIPTION (provided by applicant): Obesity is a major and increasing health problem in the United States. While many interventions have resulted in short-term weight loss, few programs exist that support successful maintenance of a healthy body weight, and fewer still are generalizable to a primary care population. Obesity tends to be a chronic, lifelong condition and relapse after weight loss is common. Despite the fact that obesity is associated with a host of medical diseases, weight interventions are usually conducted in a vacuum, divorced from the participants' usual medical care and without the input from the primary care team. Therefore, there is a great need for interventions that can assist with long-term maintenance of healthy body weight in the general population and in persons with existing medical conditions. Furthermore, such efforts should be linked to ongoing medical care. Our research team has developed an intervention - Virtual Lifestyle Management (VLM) - that successfully uses health information technology (HIT) to promote weight loss among primary care patients. We now propose to extend our work to evaluation of HIT tools designed to promote weight maintenance and prevent relapse in primary care patients who have successfully lost weight. Our proposal leverages recent developments in HIT, such as online visits and electronic health records, which enable primary care sites to contact patients and track their progress in ongoing weight maintenance efforts. We propose a randomized clinical trial - Maintaining Activity and Nutrition through Technology-Assisted Innovation in Primary Care (MAINTAIN-PC) - to test whether online tracking tools and weight maintenance "coaching" visits for patients and "real time" electronic progress reports for primary care providers (PCPs) [Continued Coaching (CC)] will support more successful weight maintenance than online tracking tools alone [Tracking Only (TO)] in a group of primary care patients who have lost e 5% of their body weight. The online coaching visits for participants will be delivered through the primary care site's electronic patiet portal (HealthTrak) and the electronic progress reports for PCPs delivered through the electronic health record (EHR). Our proposed intervention has a sound theoretical framework, incorporating both the Chronic Care Model and principles related to successful behavioral weight loss programs: self-monitoring, support, problem solving, and relapse prevention. By focusing on weight maintenance and relapse prevention, increased collaboration with primary care, and integration with existing HIT systems and tools, we will extend our previous work and fill a crucial gap in the successful treatment of obesity as a chronic medical condition.