Increasing Access to USPSTF-Recommended Obesity Care for Youth and Adults Who Are Recipients of Medicaid: Evaluation of a Comprehensive Multidisciplinary Obesity Care Training Program in FQHCs

增加获得 USPSTF 建议的医疗补助青少年和成人肥胖护理的机会：对 FQHC 综合性多学科肥胖护理培训计划的评估

• 批准号: 10737453
• 负责人: Sarah Elizabeth Hampl
• 金额: $ 71.27万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10737453
• 关键词: Address; Adoption; Adult; Affect; Affordable Care Act; Behavior Therapy; Body Weight Changes; Body Weight decreased; Caring; Child; Clinic; Clinical; Cluster randomized trial; Communities; Community Health Aides; Competence; Counseling; Data; Detection; Diagnosis; Dietitian; Discipline; Disease; Education; Effectiveness; Electronic Health Record; Eligibility Determination; Equity; Evaluation; Evidence based treatment; Federally Qualified Health Center; Future; Health; Health Personnel; Health Policy; Health Services Accessibility; Health system; Inequity; Infrastructure; Intervention; Learning; Life Expectancy; Link; Low income; Maintenance; Medicaid; Medical; Methods; Missouri; National Institute of Diabetes and Digestive and Kidney Diseases; Non-Insulin-Dependent Diabetes Mellitus; Nutritionist; Obesity; Obesity Epidemic; Outcome; Patient Care; Patients; Perception; Phase; Policies; Population; Preventive service; Provider; Quality of Care; Quality of life; Randomized, Controlled Trials; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Research; Research Personnel; Rural Community; Savings; Services; Training; Training Programs; Translations; United States Preventative Services Task Force; Weight; Work; Youth; adult obesity; arm; behavioral health; care coordination; care fragmentation; clinically significant; cohort; community clinic; community setting; contextual factors; digital technology; disability; effectiveness/implementation design; evidence base; gaps in access; health care service utilization; health inequalities; implementation barriers; implementation outcomes; implementation strategy; improved; innovation; marginalized population; multidisciplinary; obese patients; obesity in children; obesity treatment; payment; population health; primary care provider; programs; recruit; rural area; screening; service delivery; social; social health determinants; social stigma; socioeconomics; urban area

Obesity in adults and children is associated with severe disease and poor quality of life, and disproportionately impacts rural communities and historically marginalized groups. Increased access to quality obesity care is an important strategy for reducing obesity-related inequities. The US Preventive Services Task Force (USPSTF) recommends primary care providers (PCPs) screen children and adults for obesity and offer or refer to comprehensive, intensive behavioral interventions (IBTs); however, these recommendations are rarely implemented. Lack of training for both PCPs and behavioral health providers (BHPs) is a major barrier to implementation of USPSTF-care. Other key barriers include workforce challenges, care fragmentation, clinician weight bias, limited clinic-community linkages, and patient-level socioeconomic barriers. Harnessing an upcoming Medicaid policy change, our team developed a scalable implementation strategy, Comprehensive Multidisciplinary Obesity Care (CMOC). We propose to train a collaborative team (i.e., PCPs, BHPs, Registered Dietitian Nutritionists, and community health workers) to implement USPSTF-care in Federally Qualified Health Centers (FQHCs). CMOC is an innovative approach that leverages policy supports, clinic-community linkages, and digital technology, and employs a comprehensive, multi-level training program addressing structural and systemic contributors (e.g., clinician weight bias) to health inequities to improve weight-related outcomes and sustain impact. Using an effectiveness-implementation design with a cluster randomized controlled trial (RCT) phase and a one-way crossover phase, 20 FQHCs in urban and rural areas of Missouri including ~100 PCPs and ~6,000 benefit-eligible patients (i.e., Medicaid recipients with obesity) will be assigned to CMOC or an implementation as usual control (IAUC) condition. CMOC includes provider training in obesity care competencies (e.g., weight bias reduction, structural competency), discipline-specific USPSTF-care, and learning collaboratives over 12 months, followed by a 12-month sustainability period. The one-way crossover phase implements CMOC in the control arm (following their participation in IAUC) over 12 months. Both phases include evaluations at 12- and 24-months post-training. To improve health outcomes among historically marginalized groups, our proposed study evaluates short- and long-term clinical and implementation outcomes of CMOC compared to IAUC using RE-AIM. Four aims will guide this work. Aim 1 compares patient-level effectiveness (i.e., patient relative weight change (1a) and the proportion of patients who achieve clinically significant weight loss (1b)). Aim 2 compares reach (patient treatment utilization). Aim 3 compares PCP referrals to care at 12 (adoption; 3a) and 24 months (maintenance; 3b), and short- and long-term changes in provider obesity care competencies (3c). Aim 4 compares implementation and service costs. In line with NIDDK Strategic Priorities, our project seeks to advance implementation of evidence-based care in communities, ultimately expanding access to promote equity and the right to a future without disability and disease for those most in need.

成人和儿童的肥胖与严重的疾病和较差的生活质量有关，而且不成比例 影响农村社区和历史上被边缘化的群体。增加获得高质量肥胖护理的机会是一种 减少与肥胖有关的不平等现象的重要战略。美国预防服务工作组(USPSTF) 建议初级保健提供者(PCP)对儿童和成人进行肥胖筛查，并提供或参考 全面、密集的行为干预(IBTS)；然而，这些建议很少 实施。缺乏对初级保健医生和行为健康提供者(BHP)的培训是 实施USPSTF-CARE。其他关键障碍包括劳动力挑战、护理分散、临床医生 体重偏差、有限的临床-社区联系以及患者层面的社会经济障碍。利用An 即将到来的医疗补助政策变化，我们的团队制定了可扩展的实施战略，全面 多学科肥胖护理(CMOC)。我们建议培训一个协作团队(即PCP、BHP、注册 营养师、营养师和社区卫生工作者)在联邦合格的卫生机构实施USPSTF保健 中心(FQHC)。CMOC是一种创新的方法，它利用政策支持、诊所-社区联系、 和数字技术，并采用全面的、多层次的培训计划，解决结构和 导致健康不平等的系统性因素(例如，临床医生的体重偏差)，以改善与体重相关的结果和 保持冲击力。采用整群随机对照试验(RCT)的有效性实施设计 阶段和单向交叉阶段，密苏里州城市和农村地区的20个FQHC，包括约100个PCP 约6,000名符合福利条件的患者(即肥胖的医疗补助接受者)将被分配到CMOC或 实施正常控制(IAUC)条件。CMOC包括肥胖护理能力的提供者培训 (例如，减轻体重偏差、结构性能力)、特定学科的USPSTF-CARE和学习 超过12个月的协作，然后是12个月的持续期。单向交叉阶段 在控制部门实施CMOC(在他们参与IAUC之后)超过12个月。这两个阶段都包括 培训后12个月和24个月的评估。改善历史上被边缘化的人群的健康状况 我们建议的研究评估了CMOC的短期和长期临床和实施结果 与使用RE-AIM的IAUC进行比较。四个目标将指导这项工作。目标1比较患者级别的有效性 (即患者相对体重变化(1a)和达到临床显著体重的患者比例 损失(1b))。目的2比较REACH(患者治疗利用)。目标3将PCP转诊与12岁时的护理进行比较 (收养；3a)和24个月(维持；3b)，以及提供者肥胖护理的短期和长期变化 能力(3c)。目标4比较了实施和服务成本。根据NIDDK的战略优先事项， 我们的项目寻求在社区中推进循证护理的实施，最终扩大 为最需要帮助的人提供机会，以促进公平和享有无残疾和无疾病的未来的权利。