Body Mass Index (BMI) Risk Zones and Variations in Obesity Detection in Veterans with Spinal Cord Injury (SCI)

脊髓损伤 (SCI) 退伍军人的体重指数 (BMI) 风险区和肥胖检测变化

• 批准号: 10331768
• 负责人: Dan Eisenberg
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-01-01 至 2022-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10331768
• 关键词: Affect; American; Body Composition; Body mass index; Caring; Centers for Disease Control and Prevention (U.S.); Chronic Disease; Data; Detection; Deterioration; Effectiveness; Electronic Health Record; Elements; Ensure; Foundations; Future; Goals; Guidelines; Health; Healthcare; Height; Individual; Information Dissemination; Interview; Location; Logistics; Measurement; Measures; Medical; Methodology; Morbidity - disease rate; Obesity; Obesity associated disease; Overweight; Patients; Performance; Physicians; Population; Prevalence; Provider; Public Health; Reporting; Risk; Risk Marker; Services; Special Population; Spinal cord injury; Spinal cord injury patients; System; Thinness; Time; United States Department of Veterans Affairs; Variant; Veterans; Veterans Health Administration; Vulnerable Populations; Weight; Work; World Health Organization; base; cohort; comorbidity; energy balance; global health; implementation design; implementation facilitation; improved; indexing; innovation; military veteran; mortality; muscle form; obesity development; obesity management; obesity risk; screening; standard of care; trend

Background. Obesity is a chronic disease that is associated with significant morbidity and mortality, and is a national healthcare and public health concern. The prevalence of obesity is high among U.S. Veterans, with more than two-thirds being overweight or obese. The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) classify “overweight” and “obesity” as a body mass index (BMI) > 25 kg/m2 and > 30 kg/m2, respectively; as such, BMI assessment is an established standard of care that is supported by the Healthcare Effectiveness Data and Information Set (HEDIS) and is a CMS Physician Quality Reporting System (PQRS) cross-cutting measure. The Departments of Veterans Affairs and of Defense mandate annual universal BMI screening of Veterans for overweight and obesity. Significance. Obesity in individuals with spinal cord injury (SCI) is common due to changes in body composition, changes in energy balance, and a significant decrease in mobility. However, due to these changes, it is likely that BMI underestimates obesity and obesity-related risk in patients with SCI, compared to able-bodied individuals. Because of physical and logistical barriers to conducting height and weight assessments in Veterans with SCI, we suspect that BMI is not consistently measured in this population. Innovation. Appropriate detection and management of obesity in Veterans with SCI relies on consistent measurement of BMI and proper interpretation of BMI when it is assessed. To better understand the burden of obesity in this vulnerable Veteran population and to identify individuals at risk for obesity-related morbidity, we propose to describe system-wide variation in BMI assessment. In addition, we plan to determine the longitudinal associations between BMI and obesity-related risk in Veterans with SCI in order to determine if SCI-specific adjusted BMI risk zones are needed to properly recognize obesity and risk for comorbidity in this population. Specific Aims. Thus, our goals for this project are three-fold: 1) To characterize guideline-concordant BMI assessment in Veterans with SCI in FY16-FY18. 2) To qualitatively understand drivers of facility-level variation in BMI assessment in Veterans with SCI. 3) To evaluate and calibrate SCI-spceific, adjusted BMI-based morbidity risk zones in Veterans with SCI. As such, we will identify Veterans with SCI at risk for obesity-related morbidity whose obesity status, based on current conventional BMI risk zones, would be undetected. Methodology. We will determine facility-level annual proportions of Veterans with SCI that receive guideline-concordant BMI assessment; then identify elements that could influence implementation of BMI assessment strategies by interviewing Veterans and providers in pre-selected facilities; and finally calibrate BMI risk zones in this population by characterizing the functional form of the relationship between BMI and onset of obesity-related comorbidities. Next Steps. By identifying promising practices and key barriers to providing high quality guideline- concordant care to Veterans with SCI, this work hopes to inform practice and system organization for improved care and decreased undersirable variation. In future study, the information collected here will be used to design implementation and improvement strategies to facilitate guideline-concordant practices for Veterans with SCI throughout VHA, and especially in locations with currently low performance. Evaluating the need for adjusted BMI risk-zones specific to Veterans with SCI will allow providers to identify SCI patients who are at risk for obesity and the development of obesity-related disease, who may otherwise be undetected. Dissemination of these results throughout VHA will improve understanding of the risk of obesity and obesity-comorbidity in this vulnerable population.

背景是一种慢性疾病 国家医疗保健和公共卫生的关注 超过三分之二的人超重或肥胖。 疾病控制与预防中心（CDC）将“超重”和“肥胖”分类为体重 索引（BMI）> 25 kg/m2和> 30 kg/m2，因此，BMI评估是一种确定的标准 医疗保健有效性数据和信息集（HEDIS）支持的护理，并且是A CMS 医师质量报告系统（PQRS）交叉切割措施。 以及国防授权年度BMI对退伍军人进行超重和观察的筛查。 意义。 组成，能量平衡的变化以及迁移率显着降低。 变化，BMI可能低估了SCI患者的肥胖和肥胖相关风险，比较 由于身体和后勤障碍 我们怀疑在患有SCI的退伍军人的评估中，BMI并未在该人群中始终如一地衡量。 创新。 评估BMI时，对BMI进行了适当的解释。 弱势退伍军人人口的负担肥胖症，并确定与肥胖有关的人 发病率，我们建议在BMI评估中描述全系统的变化。 确定SCI退伍军人的BMI与肥胖相关风险之间的纵向关联 确定科幻特异性调整后的BMI风险Zonesk Zonesk区域是否有必要识别肥胖症和风险 该人口中的comorbidge。 因此，我们的目标是我们公众的三个目标 1）表征2016财年的SCI退伍军人中的准则BMI评估。 2）在具有SCI的退伍军人的BMI评估中，设施级变异的定性离离生。 3）评估和卡利酸盐科幻，基于BMI的SCI的基于BMI的发病风险区。 这样，我们将确定具有与肥胖相关的发病率的SCI的退伍军人，其肥胖状况，基于 当前的常规BMI风险区域将未被发现。 方法。 指南符合BMI评估； 通过采访预先选择的设施中的退伍军人和提供者来评估策略； 通过表征BMI与BMI和 与肥胖相关的合并症的发作。 下一步。 这项工作希望向老兵提供一致的护理，这项工作希望为实践和系统组织提供信息 改善了护理和不良的差异。 用于设计改进和改进策略，以促进实践性的构成影响力的事实： 在整个VHA中，尤其是在绩效较低的位置，具有SCI的退伍军人 需要针对具有SCI的退伍军人的调整后的BMI风险区，允许提供者iDive Sci 有肥胖风险和与肥胖相关疾病发展的患者，否则他们可能是 整个Vhawill的结果都不构成，改善了对 在这个脆弱人群中的肥胖和肥胖症。

项目成果

Why may patients with spinal cord injury be overlooked for obesity screening in the Veterans Health Administration? Qualitative research of the perspectives of patients and healthcare providers.

为什么退伍军人健康管理局可能会忽视脊髓损伤患者的肥胖筛查？

• DOI: 10.1080/09638288.2022.2159074
• 发表时间: 2024
• 期刊: Disability and rehabilitation
• 影响因子: 2.2
• 作者: Nevedal,AndreaL;Wu,Justina;LaVela,SherriL;Harris,AlexHS;Frayne,SusanM;Arnow,KatherineD;Barreto,NicolasB;Davis,Kristen;Eisenberg,Dan
• 通讯作者: Eisenberg,Dan

Rates, Variability, and Predictors of Screening for Obesity: Are Individuals with Spinal Cord Injury Being Overlooked?

• DOI: 10.1159/000523917
• 发表时间: 2022-05-01
• 期刊: OBESITY FACTS
• 影响因子: 3.6
• 作者: Eisenberg，Dan;LaVela，Sherri L.;Harris，Alex H. S.
• 通讯作者: Harris，Alex H. S.

The impact of the COVID-19 pandemic on individuals living with spinal cord injury: A qualitative study.

• DOI: 10.1037/rep0000469
• 发表时间: 2023-02
• 期刊: REHABILITATION PSYCHOLOGY
• 影响因子: 2.7
• 作者: LaVela, Sherri L;Wu, Justina;Nevedal, Andrea L;Harris, Alex H S;Frayne, Susan M;Arnow, Katherine D;Barreto, Nicolas B;Davis, Kristen;Eisenberg, Dan
• 通讯作者: Eisenberg, Dan

Interaction between increasing body mass index and spinal cord injury to the probability of developing a diagnosis of nonalcoholic fatty liver disease.

• DOI: 10.1002/osp4.643
• 发表时间: 2023-06
• 期刊: OBESITY SCIENCE & PRACTICE
• 影响因子: 2.2
• 作者: Eisenberg, Dan;Arnow, Katherine D.;Barreto, Nicolas B.;Davis, Kristen;LaVela, Sherri L.;Frayne, Susan M.;Nevedal, Andrea L.;Wu, Justina;Harris, Alex H. S.
• 通讯作者: Harris, Alex H. S.