Case-Management & Environmental Support to Sustain Weight Loss & Reduce CHD Risk

案例管理

基本信息

批准号：
8075549
负责人：
RANDALL SCOTT STAFFORD
金额：
$ 71.3万
依托单位：
STANFORD UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-05-01 至 2013-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8075549
关键词：
Acute Address Adherence Adult American Behavioral Body Weight decreased Breathing Businesses Caring Case Management Case Manager Cessation of life Characteristics Chronic Disease Clinic Clinical Clinical Trials Community Health Coronary heart disease County Dietitian Direct Costs Disease Outcome Education Effectiveness Effectiveness of Interventions Environment Epidemic Ethnic Origin Facilities and Administrative Costs Failure Family Health Healthcare Systems Home environment Institutes Intervention Investments Life Life Style Link Low Income Population Low income Maintenance Mediator of activation protein Medical center Modeling Neighborhoods Nurses Obesity Patient Isolation Patients Physicians Preventive Primary Care Physician Primary Health Care Productivity Randomized Randomized Clinical Trials Recommendation Relative (related person)Research Resources Risk Factors Schools Services Structure System Testing Weight Weight Gain Wing Work arm base burden of illness clinically significant cost effectiveness design evidence base experience falls heart disease prevention heart disease risk improved innovation lifestyle intervention neglect novel obesity management prevent prevention service primary outcome programs success treatment as usual weight loss intervention weight maintenance

项目摘要

DESCRIPTION (provided by applicant): Obesity is an epidemic in the U.S., with a third of adults obese. Obesity exerts enormous impact on the nation's health and economy largely through its effect on coronary heart disease (CHD) risk factors: 3 in 4 obese Americans have at least one CHD risk factor reversible through weight loss. Working within acute care-centered systems, most clinicians are unsuccessful in helping their patients lose weight or prevent weight gain. A promising and well-studied approach is integrated care delivered by nurse and dietitian case managers (CMs). Nonetheless, clinical prevention services (including CM) may be less effective if provided in isolation from patients' living environments that so often reinforce caloric excess and physical inactivity. This application leverages our extensive expertise in developing and disseminating effective CM programs (Heart to Heart, R01 HL070781). We will implement an obesity-focused CM program that focuses on established behavioral weight loss and maintenance strategies and evidence-based CHD prevention targets. We also will test the additional benefit of structured environmental support (ES) carried out by community health workers that will bridge the gap between the clinic and patients' homes and neighborhood. Our Specific Aims are to: 1) Implement innovative, primary care-based CM and CM+ES interventions in a randomized clinical trial. We will conduct this trial at a San Mateo Medical Center (SMMC) health center serving an ethnically diverse, low-income population. We will randomize 200 obese adults with at least one obesity-related CHD risk factor over 18 months to usual primary care (40 patients), CM alone (80), or CM+ES (80). Intervention patients in will receive an intensive weight loss and CHD risk intervention for 12 months, followed by 12 months of maintenance intervention. 2) Determine the effectiveness and cost-effectiveness of the CM and CM+ES for improving BMI and CHD risk factors, relative to usual care and each other. Our PRIMARY HYPOTHESIS is that patients managed through CM+ES will experience greater reductions in BMI over 24- months than those in CM. 3) Transition the favored intervention to a sustainable program, supported by the County, as well as explore opportunities for broader dissemination to other County and non-County systems. A business case for dissemination based on our findings will be critical in seeking this investment. This project will develop and test two novel models of care design to support sustained weight loss. Given the failure of current mechanisms to address obesity and elevated CHD risk, these models have the potential to provide a blueprint for primary care-based obesity services that can reduce this nation's burden of obesity, especially for low-income populations. Physician-based primary care has thus far failed to address the obesity epidemic. In a randomized clinical trial of 200 obese patients with heart disease risk factors, we will evaluate the impact of nurse and dietitian case management on weight loss and weight maintenance, as an adjunct to physician care. In addition, we will test the incremental benefit of an environmental support strategy using community health workers to help patients navigate their home and neighborhood environments to achieve weight loss. The innovative intervention model developed and evaluated in this project has the potential to provide a blueprint for successful primary care-based obesity services. PUBLIC HEALTH RELEVANCE: Physician-based primary care has thus far failed to address the obesity epidemic. In a randomized clinical trial of 200 obese patients with heart disease risk factors, we will evaluate the impact of nurse and dietitian case management on weight loss and weight maintenance, as an adjunct to physician care. In addition, we will test the incremental benefit of an environmental support strategy using community health workers to help patients navigate their home and neighborhood environments to achieve weight loss. The innovative intervention model developed and evaluated in this project has the potential to provide a blueprint for successful primary care-based obesity services.

描述（由申请人提供）：肥胖是美国的流行病，其中三分之一的成年人肥胖。肥胖症主要通过对冠心病（CHD）危险因素的影响对国家的健康和经济产生巨大影响：四分之三的肥胖美国人至少通过体重减轻而具有至少一个CHD风险因素。在以急性护理为中心的系统中，大多数临床医生在帮助患者减轻体重或预防体重增加方面失败了。护士和营养师案例经理（CMS）提供了一种有希望的综合护理。尽管如此，如果与患者的生活环境隔离，临床预防服务（包括CM）可能会降低效果，而患者的生活环境通常会增强热量过量和身体不活跃。该应用程序利用了我们广泛的专业知识来开发和传播有效的CM计划（心脏至心脏，R01 HL070781）。我们将实施一个以肥胖为重点的CM计划，该计划侧重于既定的行为减肥和维护策略以及基于证据的CHD预防目标。我们还将测试社区卫生工作者进行的结构化环境支持（ES）的额外好处，这些工作者将弥合诊所与患者的家与社区之间的差距。我们的具体目的是：1）在一项随机临床试验中实施创新的基于初级保健的CM和CM+ES干预措施。我们将在San Mateo医疗中心（SMMC）卫生中心进行此试验，该中心为种族多样的低收入人口提供服务。我们将在18个月内至少将200名与肥胖相关的冠心病危险因子至少一个肥胖的成年人随机，为通常的初级保健（40名患者），单独使用CM（80）或CM+ES（80）。干预患者将接受12个月的大量体重减轻和CHD风险干预，然后进行12个月的维护干预。 2）确定CM和CM+ES对改善BMI和CHD危险因素的有效性和成本效益，相对于通常的护理以及彼此之间的效果。我们的主要假设是，通过CM+ES管理的患者在24个月内将在BMI中比CM的患者更大。 3）过渡到县支持的可持续计划，并探索向其他县和非县系统进行更广泛传播的机会。基于我们的发现的传播业务案例对于寻求这项投资至关重要。该项目将开发和测试两种新型护理设计模型，以支持持续的体重减轻。鉴于当前机制无法应对肥胖症和冠心病风险升高，这些模型有可能为基于初级保健的肥胖服务提供蓝图，从而减轻该国的肥胖负担，尤其是对于低收入人群。迄今为止，基于医师的初级保健未能解决肥胖症流行。在200名患有心脏病危险因素的肥胖患者的随机临床试验中，我们将评估护士和营养师病例管理对体重减轻和体重维持的影响，作为医师护理的辅助手段。此外，我们将使用社区卫生工作者来测试环境支持策略的渐进益处，以帮助患者在家庭和邻里环境中导致体重减轻。在该项目中开发和评估的创新干预模型有可能为成功基于初级保健的肥胖服务提供蓝图。公共卫生相关性：迄今为止，基于医师的初级保健未能解决肥胖症流行。在200名患有心脏病危险因素的肥胖患者的随机临床试验中，我们将评估护士和营养师病例管理对体重减轻和体重维持的影响，作为医师护理的辅助手段。此外，我们将使用社区卫生工作者来测试环境支持策略的渐进益处，以帮助患者在家庭和邻里环境中导致体重减轻。在该项目中开发和评估的创新干预模型有可能为成功基于初级保健的肥胖服务提供蓝图。