Reach, Outcomes and System Impacts of the VA's National Weight Loss Program, MOVE

描述（由申请人提供）：迫切建议改变生活方式以对抗肥胖和糖尿病，但对在现实世界的临床环境中实施大规模生活方式改变计划知之甚少。退伍军人事务部的MOVE计划是全国最大的生活方式改变计划，自2005年以来有40多万人参加。我们将解决三个目标：（1）确定差异在多大程度上影响入学和参与 MOVE;（2）确定参与MOVE改善心脏代谢风险的程度;（3）确定参与对医疗保健系统资源使用和成本的影响。国家数据可从弗吉尼亚州的企业数据仓库获得，分析将在弗吉尼亚州信息学和计算基础设施（芬奇）内使用SAS进行，这是一个高性能的安全计算环境。符合MOVE参与资格标准的退伍军人，从2005年到2012年至少连续3年接受VA初级保健，将被纳入其中。多种建模策略，包括广义估计方程，将用于适当分析纵向数据。 这项研究有可能对糖尿病预防领域产生深远的影响。预期成果包括一个国家，临床为基础的计划的范围和对患者健康和卫生系统的影响开创性的知识。这项工作在几个关键领域是独一无二的：（1）MOVE是全国最大的减肥计划;（2）MOVE是在临床环境中实施的，不像更常见的基于社区的方法;（3）MOVE是一个真实世界的计划，参与者是他们的初级保健提供者推荐减肥的患者，而不是“研究志愿者”;（4）拟议的研究探讨MOVE对个人层面的健康结果和卫生系统层面的成本和资源使用的影响。虽然MOVE的结果预计比糖尿病预防计划（DPP）更温和，但初步数据表明，MOVE参与大大降低了糖尿病发病率。拟议的工作将检查BMI，CVD风险因素，糖尿病和CVD发病率，药物使用以及卫生系统成本和资源使用的改善。这项研究还将为未来的工作提供信息，例如预期效益算法和EHR工具，为医疗保健专业人员和患者提供个性化建议。 退伍军人管理局卫生系统中近四分之三的退伍军人超重或肥胖;因此，如果发现MOVE有效，约有600万退伍军人将从中受益。除了评估该计划的健康和卫生系统的影响，拟议的研究将通过确定计划参与的差异以及与减少差异相关的提供者和设施层面的因素，为MOVE实施的改进提供信息。这项工作也与退伍军人事务部以外的地方有关，因为从这些分析中吸取的经验教训将为其他医疗保健系统提供信息，在这些系统中，数百万美国人可以从类似于MOVE的生活方式改变计划中受益。

DESCRIPTION (provided by applicant): Lifestyle modification is urgently recommended to combat obesity and diabetes, yet very little is known about the implementation of large-scale lifestyle change programs in real-world clinical settings. The VA's MOVE program is the largest lifestyle change program nationwide, with over 400,000 participants since 2005. We will address three Aims: (1) To determine the extent to which disparities affect enrollment and participation in MOVE; (2) To determine the extent to which participation in MOVE improves cardio-metabolic risk; and (3) To determine the impact of participation on healthcare system resource use and costs. National data are available from the VA's Corporate Data Warehouse, and analyses will be conducted using SAS within the VA Informatics and Computing Infrastructure (VINCI), a high-performance secure computing environment. Veterans who meet eligibility criteria for MOVE participation, with at least 3 consecutive years of VA primary care from 2005 to 2012, will be included. Multiple modeling strategies, including generalized estimating equations, will be used to appropriately analyze longitudinal data. This research has the potential to profoundly impact the field of diabetes prevention. Expected results include groundbreaking knowledge of a national, clinically-based program's reach and impact on patient health and the health system. The work is unique in several key areas: (1) MOVE is the largest weight loss program nationwide; (2) MOVE is implemented within a clinical setting, unlike more common community-based approaches; (3) MOVE is a real-world program in which participants are patients recommended for weight loss by their primary care providers, rather than "study volunteers"; (4) the proposed research examines MOVE's impacts on both individual-level health outcomes and health system-level costs and resource use. While outcomes are expected to be more modest in MOVE than in the Diabetes Prevention Program (DPP), preliminary data indicate that MOVE participation substantially reduces diabetes incidence. The proposed work will examine improvements in BMI, CVD risk factors, diabetes and CVD incidence, medication usage, and health system costs and resource use. This research will also inform future work, such as an expected-benefits algorithm and EHR tool to provide healthcare professionals and patients with individualized recommendations. Nearly three quarters of veterans in the VA health system are overweight or obese; thus, approximately 6 million veterans stand to benefit from MOVE if it is found to be effective. In addition to evaluating the program's health and health system impacts, the proposed research will inform improvements in MOVE implementation by identifying disparities in program participation as well as provider- and facility-level factors associated wit reduced disparities. This work is also relevant outside of the VA, as lessons learned from these analyses will inform other health care systems where many more millions of Americans could benefit from lifestyle change programs similar to MOVE.