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在城市贫困人口等高危人群中寻找治疗肥胖的有效方法。社区卫生中心（CHC）为人们提供初级保健，无论其支付能力如何，在卫生保健改革下，社区卫生中心将为很大一部分城市贫困人口提供保健。迄今为止，最有效的减肥干预措施是频繁的医患互动、高出勤率和身体活动。这种密集的干预措施对卫生保健中心来说是一个挑战，因为它们长期人手不足，而且空间有限。而且，CHC患者通常交通不便。视频会议只需要很少的CHC空间，并且可以减少工作人员的时间和病人的运输需求。一个工作人员几乎可以在任何地方为病人主持会议。尽管基于宽带互联网为低收入人群建立干预措施似乎有悖常理，但宽带在大多数城市地区都是可用的。此外，2010年3月17日，联邦通信委员会向国会提交了一份10年国家宽带计划，将高速互联网带到90%的美国家庭。我们已经成功试点了一个多方视频会议减肥项目，使用项目提供的简单硬件和互联网接入，在CHC患者家中进行。我们使用了为肥胖CHC患者量身定制的运动方案，并为包括识字和计算能力低下的人在内的参与者群体修改了完善的营养教育和支持材料。对于拟议的疗效试验，我们将随机分配150名体重指数为e30和<50的成年CHC患者，分别参加现场减肥计划、视频会议减肥计划或常规护理对照组。我们假设，与常规治疗相比，每个活动组中有30%以上的患者在6个月时出现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席率和干预成本，并估计所有三个研究组的成本效益。这项工作可能导致一种有效和可获得的减肥干预措施，可通过CHCs和宽带互联网广泛和迅速传播。

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.