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HSR＆D CDA-2提案的首次提交，向M.D.，M.P.H. Luke Funk提供五年的薪水支持。该申请的目的是为Funk博士做好准备，以进行卫生服务研究，以弗吉尼亚州的严重肥胖症治疗。 Funk博士将通过从事培训活动，获得专家心态以及完成一项研究计划来实现这一目标，该计划着重于识别和解决对退伍军人的严重肥胖护理和减肥手术的障碍。这是VA的优先事项。国家手术国家计划体重管理总监以及VA HSR＆D的主任最近同意召集有关此主题的最先进的会议。目前，关于严重的肥胖退伍军人如何导航治疗方案知之甚少。关于为什么不到0.5％的严重肥胖退伍军人追求最有效的严重肥胖症 - 减肥手术的治疗方法，鲜为人知。本CDA应用中的主要目标是1）更好地了解严重的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）试点测试通信工具，旨在改善共同的决策并优化严重肥胖患者的治疗方法。这些目标将通过三个特定目标实现。 AIM 1涉及对严重肥胖的退伍军人和提供者（包括PCP）移动的半结构化访谈！团队成员和减肥手术计划成员。促进者和减肥手术的障碍并移动！将确定计划参与计划，以及在弗吉尼亚州进行减肥手术的提供者和患者的参与者和经验。 AIM 2涉及开发，完善和试点测试一种称为“最佳情况 /最坏情况”的通信工具，该工具旨在优化考虑减肥手术或行为体重管理的退伍军人的决策！随后，IIR将提交给足够动力的RCT资助以测试干预效果。在AIM 3中，将对全国VA PCP进行调查，以了解PCP如何在整个VA系统中管理严重肥胖的患者。此外，他们对肥胖患者如何参与此举的看法！程序将被探讨。为了促进这些研究活动及其职业发展，Funk博士将完成许多针对健康服务研究，人为因素工程，定性研究以及干预设计和评估的短课程和讲习班。定性研究和健康行为干预专家Corrine Voils博士将在此奖项中考虑Funk博士。纳西亚·萨夫达尔（Nasia Safdar）博士将在人为因素工程和职业发展方面提供专业知识。 Caprice Greenberg的联合主管将提供职业发展心态。玛格丽特·施华兹（Margaret Schwarze）的联合收入者将在试点测试通信工具方面提供专业知识。赠款完成后，Funk博士将准备好领导VA内严重肥胖治疗和减肥手术领域的独立研究计划。

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