Socioecological Factors Associated with Ethnic Disparities in Bariatric Surgery Utilization - Diversity Supplement R01MD011686

与减肥手术利用中的种族差异相关的社会生态因素 - 多样性补充资料 R01MD011686

• 批准号: 10538488
• 负责人: Sarah Elizabeth Messiah
• 金额: $ 9.75万
• 依托单位: UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-16 至 2024-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10538488
• 关键词: Black Populations; Body Weight; Body Weight decreased; COVID-19; COVID-19 pandemic; Caring; Characteristics; Clinical; Dissemination and Implementation; Environmental Risk Factor; Ethnic Origin; Ethnic group; Future; Goals; Heart Diseases; Hispanic Populations; Hospitalization; Hospitals; Individual; Interview; Maintenance; Malignant Neoplasms; Mediating; Medical; Metabolic; Modeling; Morbid Obesity; Motivation; Non-Insulin-Dependent Diabetes Mellitus; Not Hispanic or Latino; Operative Surgical Procedures; Outcome; Parents; Patients; Persons; Postoperative Care; Postoperative Period; Procedures; Provider; Resolution; SARS-CoV-2 transmission; Schedule; Surveys; Telemedicine; Time; United States; Visit; asynchronous communication; bariatric surgery; care delivery; comorbidity; effective therapy; ethnic disparity; experience; health care availability; improved; interest; parent grant; risk mitigation; satisfaction; telehealth; treatment choice

Metabolic and bariatric surgery (MBS) is a safe and medically effective treatment choice for severe obesity. Yet, despite (1) an increase in the number of MBS procedures performed in the United States annually, and (2) the fact that many express interest in MBS, only about 50% of referred or eligible persons for MBS complete the procedure. Furthermore, studies have documented Hispanics and non-Hispanic Blacks (NHB) are significantly less likely than non-Hispanic Whites (NHW) to complete MBS despite higher rates of both severe obesity and obesity-related comorbidities (e.g. type 2 diabetes, heart disease, cancer). Reasons for the ethnic group disparities in post-MBS weight loss and comorbidity resolution are largely unknown. The recent COVID-19 pandemic added greater complexity to this challenge as hospitals repeatedly cancelled elective surgeries, including MBS, to accommodate anticipated surges in COVID-19-related hospitalizations. Additionally, a significant portion of pre- and post-MBS care has moved to a telehealth model. Post-MBS patients may not be comfortable with, have the means or desire to attend in-person visits due to continued COVID-19 concerns. Beyond risk mitigation for transmission of COVID-19, telehealth for post-MBS patients may improve healthcare access for those who have limited mobility or are housebound; however, more information is needed on what these patients value from in-person visits to make telehealth more acceptable and effective. Future studies should identify individual and environmental factors, including patient motivation to use this platform of care delivery, and evaluate whether these factors are correlated with the type of provider interface used (e.g. video, audio-only, and real-time vs. asynchronous communication) and body weight outcomes. In addition, weight loss maintenance and patient experience/satisfaction with the different models of delivery should also be explored. The goal of this supplement is to enhance our current parent study survey battery with dissemination and implementation (D & I) qualitative interviews, specifically related to post-operative care delivered via telehealth in a subsample (n=40) of our MBS completers (n=200). The proposed study will focus on how patient telemedicine D & I metrics (e.g. acceptability, feasibility) differ by ethnic group. This project is within the scope of the parent grant (patient-provider relationships is one of our battery sub-domains) and enhances our ability to achieve the approved aims: (AIM 1) Identify the socioecological characteristics associated with the following four patient-determined MBS groups: (1) early-completers of MBS (< 3 months), (2) later-completers of MBS (>3 months but within 12-15 months), (3) non-completers of MBS because surgery was electively cancelled after being scheduled; and (4) non-completers due to no interest in MBS after receiving a medical referral (AIM 2) Determine how differences in Groups 1 and 2 relate to post-operative weight loss and comorbidity resolution at 6- 12- and 24-months post-MBS; and (AIM 3) Explore the mediating and moderating effects of ethnicity, intrapersonal, interpersonal, clinical and other environmental interactions on MBS completer group differences.

代谢和减肥手术（MBS）是严重肥胖症的安全且具有医学上有效的治疗选择。然而， 尽管（1）每年在美国执行的MBS程序数量增加，并且（2） 许多人对MB表示兴趣，只有约50％的推荐人或合格的人完成 程序。此外，研究已经记录了西班牙裔和非西班牙裔黑人（NHB） 尽管严重的肥胖症发生率更高，但与非西班牙裔白人（NHW）相比，完成MB的可能性较小 肥胖相关的合并症（例如2型糖尿病，心脏病，癌症）。族裔的原因 MBS后减肥和合并症的差异在很大程度上未知。最近的Covid-19 随着医院反复取消选修手术，大流行对这一挑战增加了更大的复杂性， 包括MBS在内，以适应共同19与19与19次相关住院的预期潮流。另外， 大部分MB和后MBS护理已转向远程医疗模式。 MBS后患者可能不是 由于持续的共同关注，可以舒适，有能力或渴望参加面对面的访问。 除了降低Covid-19的风险降低风险外，MBS患者的远程医疗还可以改善医疗保健 访问那些行动不便或居住的人；但是，需要更多信息 这些患者重视面对面的访问，以使远程医疗更加可接受和有效。未来的研究 应该确定个人和环境因素，包括患者使用此护理平台 交付并评估这些因素是否与使用的提供商界面类型相关（例如，视频， 仅凭音频，实时与异步交流）和体重成果。另外，减肥 还应探索对不同交付模式的维护和患者经验/满意度。 该补充的目的是通过传播和 实施（D＆I）定性访谈，特别与通过远程医疗提供的术后护理有关 在我们的MBS完成者的子样本（n = 40）中（n = 200）。拟议的研究将重点介绍如何耐心 远程医疗D＆I指标（例如可接受性，可行性）因族裔群体而异。这个项目在范围内 父母赠款（患者提供者的关系是我们的电池子之一），并增强了我们的能力 实现批准的目标：（目标1）确定与以下四个相关的社会生态特征 患者确定的MBS组：（1）MBS（<3个月），（2）MBS的后期完成者（> 3） 几个月但在12-15个月内），（3）MBS的未完成者，因为手术在 被安排； （4）由于接受医疗转诊后对MBS没有兴趣而导致的未完成者（AIM 2） 确定第1组和第2组的差异如何与术后的减肥和合并症分辨率有关 MBS后6-12和24个月； （目标3）探索种族的中介和调节作用， MBS完成者组差异上的人际，人际，临床和其他环境相互作用。