Socioecological Factors Associated with Ethnic Disparities in Bariatric Surgery Utilization - Diversity Supplement R01MD011686

代谢和减肥手术（MBS）是治疗严重肥胖症的一种安全有效的治疗选择。然而， 尽管（1）每年在美国进行的MBS程序的数量增加，并且（2） 事实上，许多人表示对MBS感兴趣，只有大约50%的被转介或符合MBS资格的人完成了 procedure.此外，研究表明，西班牙裔和非西班牙裔黑人（NHB） 与非西班牙裔白人（NHW）相比，尽管严重肥胖和 肥胖相关的合并症（如2型糖尿病、心脏病、癌症）。族群原因 MBS后体重减轻和并发症解决的差异在很大程度上是未知的。近期COVID-19 由于医院一再取消择期手术， 包括MBS，以适应COVID-19相关住院的预期激增。此外，A MBS前后护理的很大一部分已转向远程保健模式。MBS后患者可能不会 由于持续的COVID-19问题，能够接受、有能力或希望参加亲自访问。 除了降低COVID-19传播的风险外，MBS后患者的远程医疗可能会改善医疗保健 为行动不便或足不出户的人提供服务;但是，需要更多的信息， 这些患者重视亲自就诊，以使远程保健更容易接受和有效。未来的研究 应确定个人和环境因素，包括患者使用该护理平台的动机 交付，并评估这些因素是否与所使用的提供商接口的类型（例如，视频， 仅音频和实时与异步通信）和体重结果。此外，减肥 还应探讨不同分娩模式的维持情况和患者体验/满意度。 这一补充的目标是加强我们目前的父母研究调查电池与传播和 实施（D & I）定性访谈，特别是与通过远程医疗提供的术后护理有关的访谈 在我们的MBS完成者（n=200）的子样本（n=40）中。这项研究将重点关注患者如何 远程医疗D & I指标（例如可接受性、可行性）因种族群体而异。该项目属于 父母补助金（患者-提供者关系是我们的电池子域之一），并提高我们的能力， 实现批准的目标：（目标1）确定与以下四个相关的社会生态特征 患者确定的MBS组：（1）MBS早期完成者（< 3个月），（2）MBS晚期完成者（>3个月 12-15个月内），（3）MBS未完成者，因为手术在 （4）在接受医疗转介后，因对MBS不感兴趣而未完成研究（AIM 2） 确定第1组和第2组中的差异与术后体重减轻和合并症消退之间的关系， 6-MBS后12个月和24个月;和（AIM 3）探索种族的中介和调节作用， 自我、人际、临床和其他环境相互作用对MBS完成者组差异的影响。

Metabolic and bariatric surgery (MBS) is a safe and medically effective treatment choice for severe obesity. Yet, despite (1) an increase in the number of MBS procedures performed in the United States annually, and (2) the fact that many express interest in MBS, only about 50% of referred or eligible persons for MBS complete the procedure. Furthermore, studies have documented Hispanics and non-Hispanic Blacks (NHB) are significantly less likely than non-Hispanic Whites (NHW) to complete MBS despite higher rates of both severe obesity and obesity-related comorbidities (e.g. type 2 diabetes, heart disease, cancer). Reasons for the ethnic group disparities in post-MBS weight loss and comorbidity resolution are largely unknown. The recent COVID-19 pandemic added greater complexity to this challenge as hospitals repeatedly cancelled elective surgeries, including MBS, to accommodate anticipated surges in COVID-19-related hospitalizations. Additionally, a significant portion of pre- and post-MBS care has moved to a telehealth model. Post-MBS patients may not be comfortable with, have the means or desire to attend in-person visits due to continued COVID-19 concerns. Beyond risk mitigation for transmission of COVID-19, telehealth for post-MBS patients may improve healthcare access for those who have limited mobility or are housebound; however, more information is needed on what these patients value from in-person visits to make telehealth more acceptable and effective. Future studies should identify individual and environmental factors, including patient motivation to use this platform of care delivery, and evaluate whether these factors are correlated with the type of provider interface used (e.g. video, audio-only, and real-time vs. asynchronous communication) and body weight outcomes. In addition, weight loss maintenance and patient experience/satisfaction with the different models of delivery should also be explored. The goal of this supplement is to enhance our current parent study survey battery with dissemination and implementation (D & I) qualitative interviews, specifically related to post-operative care delivered via telehealth in a subsample (n=40) of our MBS completers (n=200). The proposed study will focus on how patient telemedicine D & I metrics (e.g. acceptability, feasibility) differ by ethnic group. This project is within the scope of the parent grant (patient-provider relationships is one of our battery sub-domains) and enhances our ability to achieve the approved aims: (AIM 1) Identify the socioecological characteristics associated with the following four patient-determined MBS groups: (1) early-completers of MBS (< 3 months), (2) later-completers of MBS (>3 months but within 12-15 months), (3) non-completers of MBS because surgery was electively cancelled after being scheduled; and (4) non-completers due to no interest in MBS after receiving a medical referral (AIM 2) Determine how differences in Groups 1 and 2 relate to post-operative weight loss and comorbidity resolution at 6- 12- and 24-months post-MBS; and (AIM 3) Explore the mediating and moderating effects of ethnicity, intrapersonal, interpersonal, clinical and other environmental interactions on MBS completer group differences.