Evaluation of Low Cost National Weight Loss Program in the Underserved

描述（由申请人提供）：这是Nia S. Mitchell， MD， MPH提交的NHLBI K01指导职业发展奖（RFA-HL-12-030）促进生物医学研究教师多样性的首次提交。米切尔博士的首要职业目标是成为发展和实施减肥计划的领导者，为服务不足的人群提供帮助。她的研究建议使用明智地减肥（TOPS）作为模型，以产生新的证据，证明社区项目为服务不足的人群提供服务的有效性。候选人：Mitchell博士是一名委员会认证的内科医生，也是科罗拉多大学安舒茨医学院普通内科的医学助理教授。她完成了公共卫生硕士学位，并为田纳西州医疗补助接受者进行了三次减肥项目的数据库分析，其中一次是TOPS项目，两次是weight Watchers项目。她与她的主要导师詹姆斯·o·希尔博士密切合作，她与他有一篇文章发表，两篇正在审查中。培训：拟议的K01职业发展计划以以前的研究金和早期职业发展经验为基础，重点关注需要额外培训的三个领域：1)获得地理信息系统（GIS）技能；2)提高生物统计学、计算机建模和亚群分析技能；3)提高定性研究方法的技能。因此，米切尔博士建议通过建议的研究进行密集的专题指导、重点课程、研讨会和情境学习。这些培训活动将使米切尔博士能够学习如何严格评估为服务不足人群提供服务的社区项目。导师/环境：米切尔博士和她的主要导师希尔博士组建了一个强大的导师团队，他们将指导米切尔博士完成拟议的培训和研究活动。此外，米切尔博士是科罗拉多健康与保健中心唯一一位代表性不足的少数民族研究员，也是唯一一位研究服务不足人群体重管理干预措施的研究员，这使她成为健康与保健中心的宝贵财富。研究：目前的体重管理模式在负担能力、减肥维持和实施方面存在问题，特别是在低收入和少数民族人群中，迫切需要挑战这种模式。这项研究将产生与临床实践工作直接相关的信息。目标1将确定TOPS计划在服务不足地区的覆盖范围，包括低收入和少数民族人口，这对于了解这些人口使用该计划的程度至关重要。这一目标也将有助于对章节进行分类，以进行分组分析，以确定与章节之间的可变有效性相关的特征。目标2将建立在Mitchell博士之前的研究基础上，以确定TOPS计划的六年有效性以及章节之间的差异有效性，这将允许Mitchell博士根据绩效对章节进行排名，以便将它们分为五分位数，并在目标3中进行定量研究。目标3将对TOPS方案的实施提供清晰的概念性理解，因为它发现了影响绩效的章节特征，以及如何修改这些属性以将服务于低收入人群的章节的绩效提高到最高水平。这个项目在几个方面都是创新的。也许最重要的方式是，它提供了一个范式转换的体重管理应用科学的严谨性利用

DESCRIPTION (provided by applicant): This is a first submission for an NHLBI K01 Mentored Career Development Award to Promote Faculty Diversity in Biomedical Research (RFA-HL-12-030) by Nia S. Mitchell, MD, MPH. Dr. Mitchell's overarching career goal is to be a leader in the development and implementation of weight loss programs to underserved populations. Her research proposal uses Take Off Pounds Sensibly (TOPS) as a model for generating new evidence of the effectiveness of community-based programs that provide services to underserved populations. Candidate: Dr. Mitchell is a board-certified internist and an Assistant Professor of Medicine in the Division of General Internal Medicine at the University of Colorado Anschutz Medical Campus. She has completed a Master of Public Health degree and has conducted three database analyses of weight loss programs one of the TOPS program and two of the Weight Watchers program for Tennessee Medicaid recipients. She works closely with her primary mentor, James O. Hill, PhD, with whom she has one article in press and two currently under review. Training: The proposed K01 career development plan builds on prior experience from fellowship and early career development to focus on three areas that require additional training: 1) acquiring skills in geographic information systems (GIS); 2) improving skills in biostatistics, computer modeling, and subgroup analyses; and 3) improving skills in qualitative research methods. Accordingly, Dr. Mitchell proposes intensive topical mentorship, focused coursework, seminars, and contextual learning through the proposed research. These training activities will enable Dr. Mitchell to learn how to rigorously evaluate community-based programs that provide services to underserved populations. Mentors/Environment: Dr. Mitchell and her primary mentor, Dr. Hill, have assembled a strong mentorship team who will guide Dr. Mitchell through the proposed training and research activities. Additionally, Dr. Mitchell is the only underrepresented ethnic minority researcher at the Colorado Health and Wellness Center and she is the only researcher studying weight management interventions for underserved populations, which makes her a valuable asset to the Health and Wellness Center. Research: There is a pressing need to challenge the current paradigm of weight management programs, which has problems with affordability, weight loss maintenance, and implementation especially in low income and minority populations. This study will produce information of direct relevance to those working in clinical practice. Aim 1 will determine the reach of the TOPS program into underserved areas including those with low income and ethnic minority populations, which is essential to understanding the degree to which these populations are accessing the program. This aim will also help categorize chapters for subgroup analyses to determine the features that are associated with the variable effectiveness among chapters. Aim 2 will build upon Dr. Mitchell's prior research to determine the six-year effectiveness of the TOPS program as well as the differential effectiveness among chapters, which will allow Dr. Mitchell to rank chapters based on performance so they can be divided into quintiles and studied quantitatively in Aim 3. Aim 3 will provide a clear conceptual understanding of the implementation of the TOPS program as it discovers the chapter characteristics that influence performance and how these attributes might be modified to raise performance of chapters that serve low income populations to the highest levels. Summary: This project is innovative in several ways. Perhaps the most important way is that it offers a paradigm shift in weight management by applying scientific rigor to utilize the infrastructure of a national nonprofit organization. Instead of designing a new weight loss program with minimal infrastructure for wide- spread dissemination and implementation, it rigorously studies a program that is already present in thousands of communities across the country. This project will allow for a better understanding of the effectiveness of the TOPS program, especially in underserved populations, and allow Dr. Mitchell to maximize future implementation of the program in these populations. Conduct of this mentored research and training proposal, Evaluation of a Low Cost National Weight Loss Program in the Underserved, will facilitate Dr. Mitchell's development into a nationally-recognized independent investigator and leader conducting research that fundamentally changes and improves weight management in low income and minority populations. (End of Abstract)