Will Veterans Engage in Prevention after HRA-guided Shared Decision Making?

描述(由申请人提供)： 超过一半的死亡和许多疾病可归因于四个可改变的风险因素：吸烟、超重/肥胖、缺乏运动和饮酒。这些可改变的因素与心脏病、癌症、慢性肺病和中风之间有明显的联系，这些疾病仍然是美国的主要死亡原因。我们在控制导致心脏病、癌症和中风(如高血压和高脂血症)的条件方面取得了重大改进。然而，我们在解决潜在的行为因素(例如，肥胖、烟草使用和缺乏体育活动)方面做得不够好。对于退伍军人来说，预防尤其重要，因为健康状况不佳的重大风险因素非常普遍。例如，超过70%的VHA患者超重(身体质量指数[BMI]e 25 kg/m2)和三分之一的人肥胖(BMI e 30 kg/m2)，这明显高于美国人口。吸烟在退伍军人中仍然是一个严重的问题，2010年退伍军人管理局的登记数据显示，吸烟率为20%。年轻的退伍军人患慢性病的风险特别高，因为他们比非退伍军人更有可能超重/肥胖，吸烟更严重。我们提出了一项两点两臂随机试验，与退伍军人普通护理相比，评估共享决策(SDM)干预在激活退伍军人参加有效预防服务和改善心血管风险方面的有效性。这项研究将在达勒姆和安娜堡VAMCs进行。每个ARM将有225名患者；患者将是至少有一个可修改的风险因素(肥胖、不活跃或吸烟)的VA使用者，他们目前没有参加预防服务。SDM干预将由预防教练进行；基于电话，并将使用VHA健康风险评估的结果，让退伍军人参与对话，其中个人偏好与行为和特定预防服务的选择相匹配。由此产生的预防行动计划将与退伍军人初级保健团队共享，并记录在医疗记录中。结果将在基线、1个月和6个月后由盲人研究人员获得。共同的主要结果将是改变患者激活测量(PAM)和登记参加有效预防服务的比例。次要结果是冠状动脉事件的10年风险，通过Framingham风险评分来衡量。我们还将对干预措施及其执行情况进行过程评估，以便在证明有效的情况下为今后的传播和实施提供信息。

DESCRIPTION (provided by applicant): Over half of all deaths, and many illnesses, can be attributed to four modifiable risk factors: tobacco use, overweight/obesity, physical inactivity, and alcohol use. There are clear links between these modifiable factors and heart disease, cancer, chronic lung disease, and stroke which continue to be the leading causes of death in the United States. We have made significant improvements in controlling conditions that lead to heart disease, cancer and stroke (e.g., hypertension and hyperlipidemia). We have not, however, done as well in addressing the underlying behavioral factors (e.g., obesity, tobacco use, and physical inactivity). Prevention is particularly important for Veterans because of the high prevalence of significant risk factors for poor health. For example, more than 70% of VHA patients are overweight (body mass index [BMI] e 25kg/m2) and one-third are obese (BMI e 30kg/m2), which is significantly higher than the US population. Smoking also remains a significant problem among Veterans, with VHA enrollment data from 2010 indicating a prevalence of 20%. Younger Veterans are at particularly high risk for developing chronic illnesses because they are more likely to be overweight/obese and smoke more heavily than non-Veterans. We propose a two-site, two-arm randomized trial measuring the effectiveness of a Shared Decision Making (SDM) intervention in activating Veterans to enroll in effective prevention services, and improve cardiovascular risk, compared to VA usual care. The study will be performed at the Durham, and Ann Arbor VAMCs. Each arm will have 225 patients; patients will be VA users with at least one modifiable risk factor (obese, inactive, or tobacco user) who are not currently enrolled in a prevention service. The SDM intervention will be conducted by a prevention coach; telephone based, and will use the output from VHA's Health Risk Assessment to engage Veterans in a conversation where individual preferences are matched to behaviors, and choices for specific prevention services. The resulting prevention action plan will be shared with the Veterans primary care team, and documented in the medical record. Outcomes will be obtained at baseline, 1 month and 6 months after enrollment by blinded research personnel. The co-primary outcome will be change in the Patient Activation Measure (PAM) and proportion enrolled in effective prevention services. The secondary outcome is 10-year risk of coronary events, as measured by Framingham Risk Score. We will also conduct process evaluations of the intervention and its implementation to inform future dissemination and implementation should it prove effective.