PATHWEIGH: pragmatic weight management in primary care

项目总结/文摘

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.