Will Veterans Engage in Prevention after HRA-guided Shared Decision Making?

描述（由申请人提供）： 超过一半的死亡和许多疾病可归因于四个可改变的风险因素：吸烟、超重/肥胖、缺乏体育活动和饮酒。这些可变因素与心脏病、癌症、慢性肺病和中风之间存在明显的联系，这些疾病仍然是美国的主要死亡原因。我们在控制导致心脏病、癌症和中风的疾病方面取得了重大进展（例如，高血压和高脂血症）。然而，我们在解决潜在的行为因素（例如，肥胖、吸烟和缺乏运动）。预防对退伍军人特别重要，因为健康状况不佳的重大风险因素普遍存在。例如，超过70%的VHA患者超重（体重指数[BMI] e 25 kg/m2），三分之一肥胖（BMI e 30 kg/m2），明显高于美国人群。吸烟也仍然是退伍军人中的一个重要问题，2010年的VHA登记数据显示患病率为20%。 年轻的退伍军人患慢性病的风险特别高，因为他们比非退伍军人更容易超重/肥胖和吸烟。 我们提出了一个两个网站，两个手臂的随机试验测量的有效性，共同决策（SDM）干预激活退伍军人参加有效的预防服务，并提高心血管疾病的风险，相比VA常规护理。本研究将在达勒姆和安阿伯VAMC进行。每组将有225例患者;患者将是目前未参加预防服务的VA使用者，至少有一个可改变的风险因素（肥胖、不活动或烟草使用者）。SDM干预将由预防教练进行;基于电话，并将使用VHA的健康风险评估的输出，使退伍军人参与对话，其中个人偏好与行为相匹配，并选择特定的预防服务。由此产生的预防行动计划将与退伍军人初级保健团队共享，并记录在医疗记录中。 将由设盲的研究人员在基线、入组后1个月和6个月获得结局。共同主要结局将是患者激活措施（PAM）的变化和参加有效预防服务的比例。次要结局是10年冠状动脉事件风险，通过Fragrance风险评分测量。我们还将对干预措施及其执行情况进行过程评估，以便在干预措施证明有效时为今后的传播和执行提供信息。

DESCRIPTION (provided by applicant): Over half of all deaths, and many illnesses, can be attributed to four modifiable risk factors: tobacco use, overweight/obesity, physical inactivity, and alcohol use. There are clear links between these modifiable factors and heart disease, cancer, chronic lung disease, and stroke which continue to be the leading causes of death in the United States. We have made significant improvements in controlling conditions that lead to heart disease, cancer and stroke (e.g., hypertension and hyperlipidemia). We have not, however, done as well in addressing the underlying behavioral factors (e.g., obesity, tobacco use, and physical inactivity). Prevention is particularly important for Veterans because of the high prevalence of significant risk factors for poor health. For example, more than 70% of VHA patients are overweight (body mass index [BMI] e 25kg/m2) and one-third are obese (BMI e 30kg/m2), which is significantly higher than the US population. Smoking also remains a significant problem among Veterans, with VHA enrollment data from 2010 indicating a prevalence of 20%. Younger Veterans are at particularly high risk for developing chronic illnesses because they are more likely to be overweight/obese and smoke more heavily than non-Veterans. We propose a two-site, two-arm randomized trial measuring the effectiveness of a Shared Decision Making (SDM) intervention in activating Veterans to enroll in effective prevention services, and improve cardiovascular risk, compared to VA usual care. The study will be performed at the Durham, and Ann Arbor VAMCs. Each arm will have 225 patients; patients will be VA users with at least one modifiable risk factor (obese, inactive, or tobacco user) who are not currently enrolled in a prevention service. The SDM intervention will be conducted by a prevention coach; telephone based, and will use the output from VHA's Health Risk Assessment to engage Veterans in a conversation where individual preferences are matched to behaviors, and choices for specific prevention services. The resulting prevention action plan will be shared with the Veterans primary care team, and documented in the medical record. Outcomes will be obtained at baseline, 1 month and 6 months after enrollment by blinded research personnel. The co-primary outcome will be change in the Patient Activation Measure (PAM) and proportion enrolled in effective prevention services. The secondary outcome is 10-year risk of coronary events, as measured by Framingham Risk Score. We will also conduct process evaluations of the intervention and its implementation to inform future dissemination and implementation should it prove effective.