Testing the Efficacy of a Technology-Assisted Weight Management Intervention within Patient-Centered Medical Homes: The GEM (Goals for Eating and Moving) Study

项目总结 美国预防服务工作组(USPSTF)建议初级保健提供者使用 5AS框架(评估、建议、同意、协助、安排)，为肥胖患者提供咨询。提供者 由于相互竞争的需求和较低的感知能力等障碍，经常不对患者进行咨询 这可能会导致患者出勤率较低，无法有效地进行体重管理计划。以患者为中心 医疗院可以使用基于团队的护理来解决这些障碍，将就诊人数增加到重症 管理计划，并为那些不参加的人提供体重管理服务。我们 开发和形式化评估创新的、技术辅助的5A干预措施，以促进 减肥、行为改变，并增加密集计划的注册人数(例如，Move！计划从 退伍军人事务部(退伍军人事务部)和糖尿病预防计划)。这一干预被称为 GEM(饮食和运动目标)，使用4个组件提供5AS咨询-GEM在线工具， 健康教练咨询，简短的初级保健团队咨询，以及后续电话辅导。宝石工具 是通过平板电脑在初级保健环境中提供的移动友好软件程序，以促进 由健康教练和初级保健人员提供咨询。我们的初步数据显示，创业板的干预 可行并为患者和工作人员所接受，并促进5A咨询。需要一项随机试验来 研究它对减肥和健康结果的影响。我们将进行一项整群随机对照试验 在2个城市卫生中心：退伍军人事务部纽约港和蒙特菲奥里医疗集团(MMG)内的地点 评估GEM干预与增强型常规护理的疗效。我们将招募512名患者 来自16个初级保健团队(8个来自退伍军人事务部，8个来自MMG站点)，每个团队有2个或更多的初级保健提供者。 符合条件的体重指数为≥30 kg/m2或25 kg/m2的患者，并与即将到来的原发疾病合并 护理预约将通过邮寄和后续电话进行招聘。初级保健团队中的患者 随机分为干预组和对照组，分别进行创业板干预 接受增强的日常护理。主要结果将是在1年干预结束时体重减轻。 我们将使用RE-AIM评估框架来评估REACH(符合条件的患者登记的比例)， 疗效(体重减轻和其他相关结果)、采用率(初级保健团队可接受程度)、 实施(干预保真度)和维护(体重变化和计划的可持续性 随机化后12至24个月的成分)。

PROJECT SUMMARY The United States Preventive Services Task Force (USPSTF) recommends that primary care providers use the 5As framework (Assess, Advise, Agree, Assist, Arrange) to provide counseling to obese patients. Providers frequently do not counsel patients due to barriers such as competing demands and low perceived competency which may contribute to poor patient attendance to effective weight management programs. Patient-centered medical homes can use team-based care to address these barriers, increase attendance to intensive weight management programs, and provide weight management services to those who do not to attend. We developed and formatively evaluated an innovative, technology-assisted 5As-based intervention to promote weight loss, behavior change, and increase enrollment in intensive programs (e.g. the MOVE! program from the Veteran’s Affairs (VA) and the Diabetes Prevention Program) within medical homes. This intervention, called GEM (Goals for Eating and Moving), uses 4 components to deliver 5As counseling—the GEM online tool, health coach counseling, brief primary care team counseling, and follow-up telephone coaching. The GEM tool is a mobile-friendly software program delivered via tablet computers in the primary care setting to facilitate counseling by a health coach and primary care staff. Our preliminary data suggest that the GEM intervention is feasible and acceptable to patients and staff and facilitates 5As counseling. A randomized trial is needed to examine its impact on weight loss and health outcomes. We will conduct a cluster-randomized controlled trial at 2 urban health centers: the VA New York Harbor and at sites within the Montefiore Medical Group (MMG) to assess the efficacy of the GEM intervention compared to Enhanced Usual Care. We will recruit 512 patients from 16 primary care teams (8 from VA sites, 8 from MMG sites), each with 2 or more primary care providers. Eligible patients with a Body Mass Index of ≥30 kg/m2 or >25 kg/m2 and comorbidities with upcoming primary care appointments will be recruited via mail with follow up telephone calls. Patients within primary care teams randomized to the intervention group will receive the GEM intervention and those in the control group will receive Enhanced Usual Care. The primary outcome will be weight loss at the end of the 1 year intervention. We will use the RE-AIM evaluation framework to assess the reach (proportion of eligible patients who enroll), efficacy (weight loss and other related outcomes), adoption (acceptability to primary care teams), implementation (intervention fidelity) and maintenance (sustainability of weight change and program components between 12 and 24 months post-randomization).