Identifying and Addressing Barriers to Bariatric Surgery within VA

 描述(由申请人提供)： 这是第一次提交HSR&D CDA-2提案，为Luke Funk，M.D.，M.P.H.提供五年的工资支持。这份申请的目标是为Funk博士从事专注于退伍军人事务部严重肥胖症治疗的卫生服务研究的职业生涯做好准备。芬克博士将通过开展培训活动、获得专家指导和完成一项研究计划来实现这一目标，该计划的重点是确定和解决退伍军人严重肥胖护理和减肥手术的障碍。这是退伍军人管理局的优先事项。国家外科主任、国家体重管理项目主任和退伍军人管理局HSR&D主任最近同意就这一主题召开一次最新技术会议。目前，人们对严重肥胖的退伍军人如何选择治疗方案知之甚少。人们也很少知道为什么只有不到0.5%的严重肥胖退伍军人寻求最有效的治疗严重肥胖的方法-减肥手术。CDA应用程序的主要目标是1)更好地了解严重肥胖患者和他们的初级保健提供者(PCP)如何做出肥胖治疗决定；2)试行测试一种旨在改善严重肥胖患者的共享决策和优化治疗的沟通工具。这些目标将通过三个具体目标来实现。目标1包括对严重肥胖的退伍军人和治疗他们的提供者(包括初级保健医生)进行半结构化采访！团队成员和减肥手术计划成员。减肥手术的促进者和障碍，行动起来！计划的参与以及在退伍军人管理局进行减肥手术的提供者和患者的态度和经验将被确定。目标2涉及开发、改进和试点测试一种名为“最佳情况/最坏情况”的沟通工具，该工具旨在为考虑在Move！内进行减肥手术或行为体重管理的退伍军人优化决策。随后，将提交一份IIR，以资助一项动力充足的随机对照试验，以测试干预效果。在目标3中，将对退伍军人管理局初级保健医生进行全国调查，试图了解初级保健医生如何在整个退伍军人管理局系统中管理严重肥胖患者。此外，他们对严重肥胖患者如何参与搬家的看法！计划将被探索。为了促进这些研究活动和他的职业发展，Funk博士将完成许多短期课程和研讨会，重点是卫生服务研究、人为因素工程、定性研究以及干预设计和评估。在此次颁奖期间，Funk博士将由定性研究和健康行为干预方面的专家Corine Voils博士指导。共同导师纳西亚·萨夫达尔博士将提供人因工程和职业发展方面的专业知识。联合导师卡普里斯·格林伯格将提供职业发展指导。联合导师玛格丽特·施瓦茨将提供对该通信工具进行试点测试的专业知识。在完成拨款后，芬克博士将做好充分准备，领导一个独立的研究计划，在退伍军人管理局的严重肥胖症治疗和减肥手术领域进行健康服务研究。

 DESCRIPTION (provided by applicant): This is the first submission of an HSR&D CDA-2 proposal to provide five years of salary support to Luke Funk, M.D., M.P.H. The goal of this application is to prepare Dr. Funk for a career conducting health services research focused on severe obesity treatment in VA. Dr. Funk will accomplish this goal by pursuing training activities, obtaining expert mentorship, and completing a program of research focused on identifying and addressing barriers to severe obesity care and bariatric surgery for Veterans. This is a priority for the VA. The National Director of Surgery National Program Director for Weight Management, and the Director of VA HSR&D have recently agreed to convene a State of the Art Conference on this topic. Little is currently known about how severely obese Veterans navigate treatment options. Little is also known about why less than 0.5% of severely obese Veterans pursue the most effective treatment for severe obesity - bariatric surgery. The primary objectives in this CDA application are 1) to better understand how severely obese patients and their primary care providers (PCPs) make obesity treatment decisions; and 2) to pilot-test a communication tool designed to improve shared decision-making and optimize treatment for severely obese patients. These objectives will be achieved through three specific aims. Aim 1 involves semi-structured interviews with severely obese Veterans and providers who treat them, including PCPs, MOVE! team members and bariatric surgery program members. Facilitators and barriers to bariatric surgery and MOVE! program participation as well as attitudes and experiences of providers and patients who have pursued bariatric surgery in VA will be identified. Aim 2 involves developing, refining and pilot-testing a communication tool called the "Best Case / Worst Case" communication tool which is designed to optimize decision-making for Veterans considering bariatric surgery or behavioral weight management within MOVE!. Subsequently, an IIR will be submitted to fund an adequately powered RCT to test intervention effectiveness. In Aim 3, a national survey of VA PCPs will be administered in an attempt to understand how PCPs manage severely obese patients throughout the VA system. Additionally, their perceptions regarding how severely obese patients engage with the MOVE! program will be explored. To facilitate these research activities and his career development, Dr. Funk will complete a numerous short courses and workshops focusing on health services research, human factors engineering, qualitative research, and intervention design and evaluation. Dr. Funk will be mentored during this award by Dr. Corrine Voils, an expert in qualitative research and health behavior interventions. Co-mentor Dr. Nasia Safdar will provide expertise in human factors engineering and career development. Co-mentor Caprice Greenberg will provide career development mentorship. Co-mentor Margaret Schwarze will provide expertise in pilot-testing the communication tool. Upon completion of the grant, Dr. Funk will be well-prepared to lead an independent research program in health services research in the area of severe obesity treatment and bariatric surgery within VA.