RCT of Video-Conference & In-Person Weight Loss Services for Adult CHC Patients

描述（由申请人提供）：医学研究所优先考虑确定治疗城市穷人等高危人群肥胖症的有效方法。社区保健中心向人们提供初级保健，而不论其支付能力如何，保健改革将向大部分城市穷人提供保健。迄今为止，最有效的减肥干预措施有频繁的工作人员与患者的互动，高出勤率和身体活动。这种密集的干预措施对社区卫生中心来说是一个挑战，因为它们长期缺乏人手，空间有限。而且，CHC患者的交通工具往往有限。视频会议需要很少的CHC空间，并可能减少工作人员的时间和病人的运输需求。一个工作人员可以为几乎任何地方的病人主持会议。虽然建立一个基于宽带互联网的低收入人口干预似乎违反直觉，宽带是在大多数所有的城市地区。此外，2010年3月17日，FCC向国会提交了一项为期10年的国家宽带计划，为90%的美国家庭提供高速互联网。我们已经成功地试行了一个多方视频会议减肥计划，通过该项目提供的简单硬件和互联网接入，在CHC患者的家中向他们提供。我们已经使用了一个运动协议量身定制的肥胖CHC患者和完善的营养教育和支持材料修改的参与人群，包括识字和算术技能低的人。对于拟议的疗效试验，我们将150名体重指数e30和<50的成人CHC患者随机分配到面对面减肥计划，视频会议减肥计划或常规护理对照组。我们假设，与常规护理相比，每个活动组中有30%以上的人在6个月时会有临床显著的体重减轻（e2 kg），并将保持这种体重减轻12个月。将比较干预组之间的出勤率和干预成本，并估计所有三个研究组的成本效益。这项工作可能会产生一种有效和可获得的减肥干预措施，可以通过社区卫生中心和宽带互联网广泛和迅速地传播。 公共卫生相关性：这个项目将测试每周两次的减肥课程是否会比平时的护理更有效。参与者将是社区卫生中心的肥胖、中年患者。课程包括渐进式锻炼和营养教育，专为具有一系列识字和算术技能的人口设计。

DESCRIPTION (provided by applicant): The Institute of Medicine gives top priority to identifying effective methods of treating obesity in at-risk populations such as the urban poor. Community health centers (CHC) provide primary care to persons regardless of ability to pay and under health care reform will be providing care to a large proportion of urban poor. To date, the most effective weight loss interventions have had frequent staff-patient interactions, high attendance, and physical activity. Such intensive interventions are a challenge for CHCs because they are chronically short staffed and have limited space. And, CHC patients often have limited transportation. Video-conferencing requires very little CHC space, and may reduce staff time and patient transportation needs. A single staff person can lead meeting sessions for patients located virtually anywhere. Although building an intervention for lower income populations based on broadband Internet may seem counterintuitive, broadband is available in most all urban areas. Additionally, on March 17, 2010, the FCC delivered a 10-year National Broadband Plan to Congress to bring high-speed Internet to 90% of U.S. homes. We have successfully piloted a multiparty video-conference weight loss program delivered to CHC patients in their homes using simple hardware and Internet access supplied by the project. We have used an exercise protocol tailored to obese CHC patients and well-established nutrition education and support materials modified for a participant population that includes persons with low literacy and numeracy skills. For the proposed efficacy trial we will randomize 150 adult CHC patients with body-mass index e30 and <50 to either an in-person weight loss program, a video-conference delivered weight loss program, or to a usual care control group. We hypothesize that, compared to usual care, 30% more persons in each of the active arms will have a clinically significant weight loss (e2 kg) at 6-months, and will maintain this weight loss a 12-months. Attendance and intervention costs will be compared between intervention arms and cost-effectiveness will be estimated for all three study arms. This work could result in an effective and accessible weight loss intervention that could be widely and rapidly disseminated through CHCs and broadband Internet. PUBLIC HEALTH RELEVANCE: This project will test whether twice-weekly weight loss classes delivered either in-person or via video-conference lead to greater weight loss than usual care. Participants will be obese, middle-aged patients of community health centers. Classes consist of progressive exercise and nutrition education designed for a population with a range of literacy and numeracy skills.