A Study of Trends in Obesity Progression among Complex Patients

描述(申请人提供)：肥胖症占美国所有死亡人数的15%。在2007-2008年间，成年人肥胖率为33.8%。肥胖可能会逆转美国人口吸烟率下降带来的净收益。它会导致过早死亡并降低生活质量，而抑郁和心血管疾病等令人衰弱的并存疾病的频繁并存又进一步影响了这两种疾病。这意味着巨大的健康和经济成本。我们提出了一个创新的探索性研究项目，重点关注患有三种慢性疾病的患者：(1)肥胖，(2)高血压和(3)抑郁症。在帕洛阿尔托医学基金会研究所(PAMFRI)组建了一个能力互补的小组进行分析流行病学研究，该研究所是AHRQ行动网络的成员，也是帕洛阿尔托医学基金会(PAMF)的一个组成部分，PAMF是一个大型的非营利性多专业交付系统。PAMF自2000年起实施EpicCare电子健康记录(EHR)系统。PAMF正在进行与这三种疾病相关的许多研究和质量改进工作，包括由美国国立卫生研究院和美国心脏协会联合资助的一项研究，题为《治疗心脏代谢风险升高的生活方式干预措施的评估》(E-LITE)。在PAMF的一家诊所正在进行的E-Lite是一项随机对照试验(RCT)，涉及两种非常成功的生活方式干预的改良形式，用于治疗超重或肥胖的成年人。具体目标是：(1)利用2000年至2010年的EHR数据，追踪单纯性肥胖患者与肥胖-高血压-抑郁组合患者的临床路径。我们将检查这些患者接受的干预措施，包括但不限于肥胖或精神健康的共享医疗预约、减肥手术、行为干预和药物治疗。我们将评估按年龄、性别、种族和疾病状态分层的患者的病情进展情况，并评估各种干预措施的影响。(2)利用在E-Lite中前瞻性收集的数据来检查对具有三种优先条件的不同组合的E-Lite患者亚组进行强化生活方式干预的有效性。我们将测试高血压和/或抑郁症的存在是否会影响E-Lite干预措施在减少肥胖和心脏代谢风险方面的有效性。(3)评估E-LITE中的患者和医生样本在多大程度上代表了PAMF研究诊所和其他诊所的患者和医生。我们将比较E-Lite中患者参与者的特征和临床轨迹，以及在该诊所或PAMF其他地方也有肥胖的非参与者患者。我们还将在PAMF比较E-Lite医生和非E-Lite医生的执业风格。这项研究的结果可以为目前的PAMF和管理肥胖-高血压-抑郁症患者的国家质量改进措施和治疗指南提供参考，肥胖-高血压-抑郁症是一系列常见且昂贵的优先疾病。 与公共健康相关：在美国，肥胖占死亡的15%。高血压和抑郁症也是导致残疾的主要原因，而且经常与肥胖并存。我们提出了一个创新的探索性研究项目，重点关注患有三种慢性疾病的患者：(1)肥胖，(2)高血压和(3)抑郁症。我们将在一个拥有超过650,000名患者的大型医疗实践中评估这些情况的进展情况。这项研究的结果可以为目前地方和国家的质量改进措施和治疗指南提供参考，以管理这一常见且昂贵的优先疾病星座的患者。

DESCRIPTION (provided by applicant): Obesity accounts for up to 15% of all deaths in the U.S. In 2007-2008, the prevalence of obesity among adults was 33.8%. Obesity threatens to reverse the net benefit of declining smoking rates on the U.S. population. It contributes to untimely mortality and reduces quality of life, both of which are further influenced by the frequent co-occurrence of debilitating co-morbidities including depression and cardiovascular diseases. This translates to tremendous health and economic costs. We propose an innovative exploratory research project focusing on patients with a constellation of three chronic conditions: (1) obesity, (2) hypertension, and (3) depression. A team with complementary capacities has been assembled for an analytical epidemiological study at the Palo Alto Medical Foundation Research Institute (PAMFRI), an AHRQ ACTION network member and a component of the Palo Alto Medical Foundation (PAMF), a large non-profit multi-specialty delivery system. PAMF has implemented the EpicCare Electronic Health Record (EHR) system since 2000. Many research and quality improvement efforts related to these three conditions are ongoing at PAMF, including a study jointly funded by the NIH and the American Heart Association, entitled Evaluation of Lifestyle Interventions to Treat Elevated cardiometabolic risk (E-LITE). Underway at one PAMF clinic, E-LITE is a randomized controlled trial (RCT) of two modified forms of a highly successful lifestyle intervention to treat overweight or obese adults. The specific aims are to: (1) Follow the clinical paths of patients with obesity alone versus with the obesity-hypertension-depression constellation, using EHR data from 2000 to 2010. We will examine the interventions these patients receive, including but not limited to, shared medical appointments for obesity or mental health, bariatric surgery, behavioral interventions, and pharmacologic treatment. We will evaluate the progression of the conditions in the constellation among patients stratified by age, gender, race, and disease states and assess the impact of various interventions. (2) Leverage the prospectively collected data in E-LITE to examine the effectiveness of intensive lifestyle interventions for subsets of E-LITE patients with various combinations of the three priority conditions. We will test if the presence of hypertension and/or depression influences the effectiveness of E-LITE interventions in reducing obesity and cardiometabolic risk. (3) Assess how well the sample of patients and physicians in E-LITE represents the patients and physicians in the study clinic and other clinics in PAMF. We will compare characteristics and clinical trajectories of patient participants in E-LITE with non-participating patients who also have obesity in that clinic or elsewhere in PAMF. We will also compare practice styles of E-LITE physicians with non-E-LITE physicians at PAMF. Results of the study can inform current PAMF and national quality improvement measures and treatment guidelines for managing patients with obesity-hypertension-depression, a common and costly constellation of priority conditions. PUBLIC HEALTH RELEVANCE: Obesity accounts for up to 15% of death in the U.S. Hypertension and depression are also leading causes of disability and often co-occur with obesity. We propose an innovative exploratory research project focusing on patients with a constellation of three chronic conditions: (1) obesity, (2) hypertension, and (3) depression. We will evaluate the progression of these conditions in a constellation in a large medical practice with over 650,000 patients. Results of the study can inform current local and national quality improvement measures and treatment guidelines for managing patients with this common and costly constellation of priority conditions.