Measuring the Longitudinal Relationshipsbetween Obesity, Weight Management Intervention, and Medical Expenditure

测量肥胖、体重管理干预和医疗支出之间的纵向关系

• 批准号: 10759361
• 负责人: MATTHEW L MACIEJEWSKI
• 金额: --
• 依托单位: DURHAM VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-06-01 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10759361
• 关键词: Address; Adoption; Adult; Affect; Algorithms; Behavior Therapy; Behavioral; Big Data; Body Weight decreased; Body mass index; Businesses; Caring; Characteristics; Clinical; Complement component C4; Coronary heart disease; Counseling; Data Sources; Degenerative polyarthritis; Disease; Economics; Effectiveness; Eligibility Determination; Expenditure; Goals; Health; Health Expenditures; Health Promotion; Healthcare; Hypertension; Individual; Informatics; Intervention; Lead; Life Style; Longitudinal trends; Measures; Medical; Morbid Obesity; Natural History; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Outcome; Overweight; Patient-Centered Care; Patients; Pattern; Pharmacotherapy; Policy Analysis; Population; Prevalence; Research; Resources; Risk; Running; Strategic Planning; Subgroup; Systems Integration; Validation; Veterans; Weight; Weight Gain; Weight maintenance regimen; bariatric surgery; clinical risk; disorder prevention; economic evaluation; economic impact; economic outcome; experience; follow-up; improved; improved outcome; machine learning method; obese patients; obesity risk; obesity treatment; population based; population health; preventable death; programs; research clinical testing; symposium; treatment effect; trend; weight loss intervention

The prevalence of obesity among adults is stabilizing after decades of unrelenting increases and about 68% of Veterans are considered either overweight or obese. Obesity is the second leading cause of preventable deaths in the US and is associated with a wide range of diseases, such as hypertension, type 2 diabetes mellitus, coronary heart disease, and osteoarthritis. These clinical risks lead obese patients to incur disproportionately high health expenditures. In 2008, annual health expenditures attributable to obesity were estimated to be $147 billion, concentrated among morbidly obese patients. In 2013, 28.2% of overall health expenditures for adults was incurred for obesity-associated care. Currently, three types of weight management interventions are available to overweight and obese VA patients: behavioral lifestyle counseling, pharmacotherapy and bariatric surgery. The most widely used of these interventions is behavioral counseling through the MOVE! program. Despite the widespread adoption of MOVE! as a first line treatment for obesity in VA, MOVE! participation has been associated with modest short- term weight loss and evidence is absent regarding the clinical and economic effectiveness of MOVE! beyond a 12-month follow-up. No prior VA studies have examined the natural history of weight gain, long-term expenditures of normal weight, overweight and obese Veterans, or changes in weight and expenditures attributable to MOVE!. It is important to understand longitudinal (20-year) patterns of VA healthcare expenditures by BMI progression to characterize the long-run scope of the problem of obesity in VA. Such results will then provide significant context for evaluating the health and economic effectiveness of MOVE! participation. Taken together, the four specific aims will enable an examination of impact of MOVE! on Veteran outcomes in the context of VA's overall population-level weight management strategy on eligible Veterans: Aim 1: Identify latent classes of different BMI progression trajectories between 2000-2019. Aim 2: Estimate differences in long term VA expenditures between latent BMI classes. Aim 3: Identify the average treatment effect of MOVE! and characteristics of Veterans who experience the greatest weight reductions following MOVE! participation. Aim 4: Identify the average treatment effect of MOVE! on expenditures and characteristics of Veterans who experience the greatest reduction in VA expenditures following MOVE! participation. Next Steps: The examination of 20-year expenditures associated with obesity and differential effects of MOVE! responds to one of the top four strategic goals identified in the VA FY 2018-2024 Strategic Plan by informing approaches to focus resources more efficiently. This study also addresses HSR&D's cross-cutting priority of business case and policy analysis and the Healthcare Informatics priority through the analysis, validation, and application of Big Data sources to improve individual and population health. This research will also enable us to formalize an algorithm to identify patients most likely to benefit from MOVE!, as well as those unlikely to achieve significant clinical weight loss through MOVE!. Following identification of Veterans at greatest risk for obesity and high VA expenditures, and of Veterans who experience the greatest weight and expenditure improvements following weight loss intervention, we will partner with NCP to determine how best to implement a prioritization strategy to develop need-tailored behavioral programs.

成年人肥胖的流行率在经历了几十年的无情增长后正在稳定下来， 68%的退伍军人被认为超重或肥胖。肥胖是导致肥胖的第二大原因 可预防的死亡，并与广泛的疾病，如高血压，2型 糖尿病、冠心病和骨关节炎。这些临床风险导致肥胖患者 不成比例的高额医疗费用。2008年，每年用于肥胖的医疗费用为 估计为1470亿美元，集中在病态肥胖患者中。2013年，28.2%的健康 成年人的支出用于与肥胖相关的护理。 目前，三种类型的体重管理干预措施可用于超重和肥胖的VA 患者：行为生活方式咨询、药物治疗和减肥手术。中使用最广泛的一种 这些干预措施是通过MOVE行为咨询!程序.尽管广泛采用 动起来!作为VA肥胖症的一线治疗，MOVE!参与者与适度的短- 长期减肥和证据是缺乏关于MOVE!超过 12-月随访。以前没有VA研究检查体重增加的自然史，长期 正常体重、超重和肥胖退伍军人的支出，或体重和支出的变化 因为感动!了解VA医疗保健的纵向（20年）模式非常重要 通过BMI进展来表征VA中肥胖问题的长期范围。等 结果将为评估MOVE! 参与的这四个具体目标合在一起，将使我们能够审查MOVE的影响!以veteran 在VA对合格退伍军人的总体人群水平体重管理策略的背景下，结果如下： 目标1：确定2000 - 2019年间不同BMI进展轨迹的潜在类别。 目的2：估计潜在BMI类别之间长期VA支出的差异。 目标3：确定MOVE的平均治疗效果!和经历过的退伍军人的特点 最大的重量减少后移动!参与的 目标4：确定MOVE的平均治疗效果!关于退伍军人的支出和特点， 体验MOVE后VA支出的最大减少!参与的 下一步：检查与肥胖相关的20年支出和肥胖的不同影响。 动起来!响应VA 2018 - 2024财年战略计划中确定的四大战略目标之一， 为更有效地集中资源提供信息。本研究还讨论了HSR & D的交叉问题， 业务案例和政策分析的优先级以及通过分析的医疗保健信息学优先级， 验证和应用大数据源，以改善个人和人群的健康。这项研究将 也使我们能够正式确定一种算法，以确定最有可能从MOVE!中受益的患者，以及那些 不太可能通过MOVE!实现显著的临床体重减轻。在确定退伍军人身份后， 肥胖和高VA支出的风险最大，经历最大体重和 减肥干预后的支出改善，我们将与NCP合作，以确定如何最好地 实施优先级战略，以制定符合需求的行为计划。