Identifying and Addressing Barriers to Bariatric Surgery within VA

识别并解决 VA 内减肥手术的障碍

• 批准号: 9922674
• 负责人: Luke M Funk
• 金额: --
• 依托单位: WM S. MIDDLETON MEMORIAL VETERANS HOSP
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-03-01 至 2021-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9922674
• 关键词: Address; Algorithms; Area; Attitude; Award; Bariatrics; Behavior Therapy; Behavioral; Body Weight decreased; Body mass index; Cardiovascular Diseases; Caring; Cause of Death; Clinical; Communication; Communication Tools; Complication; Computerized Patient Records; Consultations; Data; Decision Making; Diabetes Mellitus; Diet; Doctor of Medicine; Educational workshop; Effectiveness; Effectiveness of Interventions; Elements; Endocrinology; Engineering; Evaluation; Exercise; Face; Funding; Goals; Grant; Health; Health Promotion; Health Services Research; Health behavior; Healthcare Systems; Human; Interview; Lead; Longevity; Master of Public Health; Medical; Mentors; Mentorship; Metabolic; Methods; Monitor; Morbid Obesity; Nurses; Obesity; Operative Surgical Procedures; Patient Care; Patient Preferences; Patients; Perception; Physiological; Practice Management; Prevention; Primary Health Care; Provider; Qualitative Research; Quality of life; Randomized Controlled Trials; Recommendation; Research; Research Activity; Research Design; Resolution; Risk; Sampling; Societies; Specific qualifier value; Standardization; Structure; Surgeon; Surveys; System; Testing; Training; Training Activity; Veterans; Wages; Weight; Weight maintenance regimen; Work; bariatric surgery; barrier to care; care providers; career; career development; comorbidity; cost; design; effective intervention; effective therapy; effectiveness evaluation; experience; health administration; high risk; improved; interest; learning strategy; member; mortality; obesity treatment; programs; shared decision making; symposium; system-level barriers; systematic review; therapy design; treatment choice; treatment optimization

 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.

 描述（由申请人提供）： 这是首次提交 HSR&D CDA-2 提案，旨在为医学博士、公共卫生硕士 Luke Funk 提供五年工资支持。此应用程序的目标是为 Funk 博士从事专注于退伍军人事务部严重肥胖治疗的健康服务研究的职业做好准备。芬克博士将通过开展培训活动、获得专家指导以及完成一项研究计划来实现这一目标，该计划的重点是识别和解决退伍军人严重肥胖护理和减肥手术的障碍。这是 VA 的首要任务。国家外科主任、国家体重管理项目主任和 VA HSR&D 主任最近同意就这一主题召开一次最先进的会议。目前对于严重肥胖的退伍军人如何选择治疗方案知之甚少。为什么只有不到 0.5% 的严重肥胖退伍军人寻求治疗严重肥胖最有效的治疗方法——减肥手术，这一点也知之甚少。此 CDA 应用程序的主要目标是 1) 更好地了解严重肥胖患者及其初级保健提供者 (PCP) 如何做出肥胖治疗决策； 2) 试点测试一种旨在改善共同决策并优化严重肥胖患者治疗的沟通工具。这些目标将通过三个具体目标来实现。目标 1 涉及对严重肥胖退伍军人和治疗他们的提供者（包括 PCP）进行半结构化访谈，MOVE！团队成员和减肥手术计划成员。减肥手术的促进者和障碍以及 MOVE！将确定在 VA 进行减肥手术的计划参与以及提供者和患者的态度和经验。目标 2 涉及开发、完善和试点测试一种称为“最佳情况/最坏情况”通信工具的通信工具，该工具旨在优化退伍军人在 MOVE! 中考虑减肥手术或行为体重管理的决策。随后，将提交 IIR 来资助一项充分有力的随机对照试验，以测试干预措施的有效性。在目标 3 中，将对 VA PCP 进行全国调查，试图了解 PCP 如何管理整个 VA 系统中的严重肥胖患者。此外，他们对严重肥胖患者如何参与 MOVE! 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，芬克博士将完成大量短期课程和研讨会，重点关注卫生服务研究、人为因素工程、定性研究以及干预设计和评估。 Funk 博士在获奖期间将得到定性研究和健康行为干预专家 Corrine Voils 博士的指导。共同导师 Nasia Safdar 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 Caprice Greenberg 将提供职业发展指导。联合导师玛格丽特·施瓦兹 (Margaret Schwarze) 将提供该通信工具试点测试方面的专业知识。拨款完成后，Funk 博士将做好充分准备，领导 VA 内严重肥胖治疗和减肥手术领域的健康服务研究独立研究项目。

项目成果

Obesity as a disease: has the AMA resolution had an impact on how physicians view obesity?

• DOI: 10.1016/j.soard.2016.05.009
• 发表时间: 2016-08
• 期刊: Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery
• 作者: Funk LM;Jolles SA;Voils CI
• 通讯作者: Voils CI

Deficiencies in postoperative surveillance for veterans with gastrointestinal cancer.

对患有胃肠道癌症的退伍军人的术后监测存在缺陷。

• DOI: 10.1002/jso.25333
• 发表时间: 2019
• 期刊: Journal of surgical oncology
• 影响因子: 2.5
• 作者: Taylor,LaurenJ;Xu,Kerui;Maloney,JamesD;Voils,CorrineI;Weber,SharonM;Funk,LukeM;Abbott,DanielE
• 通讯作者: Abbott,DanielE