PATHWEIGH: pragmatic weight management in primary care

PATHWEIGH：初级保健中的实用体重管理

• 批准号: 10264894
• 负责人: JODI Summers HOLTROP
• 金额: $ 61.32万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-17 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10264894
• 关键词: Address; Adopted; Adoption; Affect; Body Weight decreased; Clinic; Clinical Data; Cluster randomized trial; Colorado; Communities; Complex; Computerized Medical Record; Cost Analysis; Data; Data Analyses; Data Collection; Diagnosis; Disease; Education; Effectiveness; Epidemic; Family; Family Practice; Family health status; Glucose; Health; Insurance Carriers; Internal Medicine; Intervention; Interview; Lead; Life Style; Mainstreaming; Maintenance; Mediator of activation protein; Medical; Methods; Modeling; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Outcome; Overweight; Patients; Pilot Projects; Plant Roots; Practical, Robust Implementation and Sustainability Model; Primary Health Care; Process; Provider; Randomized; Recommendation; Recording of previous events; Research; Resources; Risk Factors; Site; Smoking; Surveys; System; Testing; Time; Training; United States; Universities; Visit; Weight; Weight Gain; Weight maintenance regimen; Work; comorbidity; contextual factors; cost; effectiveness implementation study; effectiveness testing; evidence base; hybrid type 1 study; implementation strategy; innovation; multilevel analysis; novel; obesity management; patient population; preventable death; service delivery; standard of care; success; tool; trial design

Project Summary/Abstract Obesity – with its many comorbid conditions – has now surpassed smoking as the leading cause of preventable death in the United States. Despite the fact that obesity is both treatable and preventable, treating the comorbidities, rather than obesity per se remains the mainstay of therapy. Importantly, obesity is being increasingly recognized not only as a risk factor for disease, but a disease unto itself. Despite this fact, <1% of people with any degree of overweight or obesity are offered anything other than lifestyle advice. Reasons for lack of weight management prioritization are extensive and complex. Effectively, the major stakeholders, including people with obesity, their clinicians and insurers, have yielded to the epidemic. Thus, there is a critical need to systematically address these diverse barriers with pragmatic approaches and evidence that facilitates the practice of weight management. To address this gap, the University of Colorado Health Family Medicine clinic in Westminster, Colorado developed PATHWEIGH. PATHWEIGH prioritizes weight management in primary care by: 1) using a designated, time-efficient flowsheet built into EPIC (the most widely utilized electronic medical record (EMR) system in the U.S.) that guides and captures history around weight gain and recommendations for weight loss, as well as practical issues related to diagnosis and billing, and 2) clinician and team training on a) use of PATHWEIGH as a tool, and b) education on current effective practices for weight management. Our pilot study demonstrated the ability to effectively implement PATHWEIGH in a primary care clinic that lead to significant improvement in patient weight loss over 18 months. The overall objective for the proposed work is to test the effectiveness of PATHWEIGH vs. standard of care in 57 primary care clinics that span diverse settings, patient populations and community contexts, as well as to examine methods to optimize implementation. Our specific aims include: 1) Evaluate the implementation of PATHWEIGH and determine its effectiveness versus control clinics using standard of care (SOC) on patient weight loss at 6 months (primary) and weight loss maintenance at 12 and 18 months (secondary) for weight- prioritized visits in primary care, 2) Identify predictors of patient weight loss and weight loss maintenance using mediator and moderator analysis, including relevant patient, provider and clinic-level variables, and 3) Examine contextual factors affecting the adoption, implementation and sustainability of PATHWEIGH using the Practical, Robust, Implementation and Sustainability Model (PRISM). To complete these aims, we will utilize a stepped wedge cluster randomized trial. Data collection and analysis methods include clinical data, surveys, observations and interviews using statistical, qualitative and mixed methods. PATHWEIGH has the potential to be a scalable, low-cost, pragmatic approach to obesity. The rationale that underlies the proposed research is that the ultimate success of PATHWEIGH relies on understanding how to implement evidence- based weight management interventions and make them most effective, used and maintained in practice.

项目概要/摘要 肥胖及其许多合并症现已超过吸烟，成为可预防疾病的主要原因 在美国死亡。尽管肥胖既可以治疗又可以预防，但治疗肥胖 合并症，而不是肥胖本身，仍然是治疗的支柱。重要的是，肥胖正在 人们越来越认识到，它不仅是疾病的危险因素，而且本身也是一种疾病。尽管如此，<1% 的 对于任何程度的超重或肥胖的人，除了生活方式建议外，我们还会提供其他任何建议。原因 体重管理优先顺序的缺乏是广泛而复杂的。实际上，主要利益相关者， 包括肥胖症患者、他们的临床医生和保险公司，都已经屈服于这种流行病。因此，有一个 迫切需要通过务实的方法和证据系统地解决这些不同的障碍 促进体重管理的实践。为了解决这一差距，科罗拉多大学健康家庭 科罗拉多州威斯敏斯特的医学诊所开发了 PATHWEIGH。 PATHWEIGH 优先考虑重量 通过以下方式在初级保健中进行管理：1) 使用 EPIC 中内置的指定的、省时的流程图（最 在美国广泛使用的电子病历 (EMR) 系统）可指导和捕获周围的历史记录 体重增加和减肥建议，以及与诊断和计费相关的实际问题， 2) 临床医生和团队培训 a) 使用 PATHWEIGH 作为工具，以及 b) 关于当前有效的教育 体重管理的实践。我们的试点研究证明了有效实施的能力 PATHWEIGH 在一家初级保健诊所中使用，显着改善了 18 岁以上患者的体重减轻情况 几个月。拟议工作的总体目标是测试 PATHWEIGH 与标准的有效性 57 个初级保健诊所提供医疗服务，涵盖不同的环境、患者群体和社区背景 研究优化实施的方法。我们的具体目标包括： 1) 评估实施情况 PATHWEIGH 并确定其与使用患者护理标准 (SOC) 的对照诊所相比的有效性 6 个月时减肥（主要）和 12 个月和 18 个月时维持减肥（次要） 初级保健中的优先就诊，2) 确定患者体重减轻和体重减轻维持的预测因素 使用中介者和调节者分析，包括相关患者、提供者和诊所层面的变量，以及 3) 使用以下方法检查影响 PATHWEIGH 采用、实施和可持续性的背景因素 实用、稳健、实施和可持续性模型 (PRISM)。为了完成这些目标，我们将 利用阶梯楔形聚类随机试验。数据收集和分析方法包括临床数据、 使用统计、定性和混合方法进行调查、观察和访谈。 PATHWEIGH 具有 有望成为一种可扩展、低成本、务实的肥胖治疗方法。拟议的基本原理 研究表明 PATHWEIGH 的最终成功取决于了解如何实施证据- 基于体重管理干预措施，并使其在实践中最有效、最有效地使用和维持。