RCT of Video-Conference & In-Person Weight Loss Services for Adult CHC Patients

视频会议RCT

• 批准号: 8296145
• 负责人: DANIEL O CLARK
• 金额: $ 58.69万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-04-03 至 2016-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8296145
• 关键词: Adult; Behavior; Behavior Therapy; Blood Pressure; Body Weight decreased; Body mass index; Caring; Community Health Centers; Congresses; Control Groups; Country; Disease; Energy Intake; Energy Metabolism; Exercise; Foundations; Group Meetings; Health; Health Care Costs; Health Care Reform; Health system; Holly; Home environment; Image; Institute of Medicine (U.S.); Interactive Communication; Internet; Intervention; Lead; Location; Low Income Population; Medical; Methods; Modeling; Monitor; Obesity; Outcome; Participant; Patients; Persons; Physical activity; Population; Populations at Risk; Primary Health Care; Process; Protocols documentation; Public Health; Public Hospitals; Randomized; Reporting; Research; Research Priority; Resources; Risk; Sampling; Self Efficacy; Services; Social Network; Social support; Solutions; Speed; Support Groups; System; Testing; Text; Time; Training; Transportation; Transportation of Patients; Travel; United States National Institutes of Health; Work; Writing; active method; arm; base; clinically significant; comparative effectiveness; cost; cost effective; cost effectiveness; design; editorial; effectiveness research; efficacy trial; ethnic minority population; health related quality of life; high risk; improved; intervention program; literacy; meetings; middle age; new technology; nutrition; nutrition education; obesity treatment; opportunity cost; population based; programs; safety net; skills; social cognitive theory; sound; symposium; three-arm study; treatment as usual; urban area; waist circumference; weight loss intervention

DESCRIPTION (provided by applicant): The Institute of Medicine gives top priority to identifying effective methods of treating obesity in at-risk populations such as the urban poor. Community health centers (CHC) provide primary care to persons regardless of ability to pay and under health care reform will be providing care to a large proportion of urban poor. To date, the most effective weight loss interventions have had frequent staff-patient interactions, high attendance, and physical activity. Such intensive interventions are a challenge for CHCs because they are chronically short staffed and have limited space. And, CHC patients often have limited transportation. Video-conferencing requires very little CHC space, and may reduce staff time and patient transportation needs. A single staff person can lead meeting sessions for patients located virtually anywhere. Although building an intervention for lower income populations based on broadband Internet may seem counterintuitive, broadband is available in most all urban areas. Additionally, on March 17, 2010, the FCC delivered a 10-year National Broadband Plan to Congress to bring high-speed Internet to 90% of U.S. homes. We have successfully piloted a multiparty video-conference weight loss program delivered to CHC patients in their homes using simple hardware and Internet access supplied by the project. We have used an exercise protocol tailored to obese CHC patients and well-established nutrition education and support materials modified for a participant population that includes persons with low literacy and numeracy skills. For the proposed efficacy trial we will randomize 150 adult CHC patients with body-mass index e30 and <50 to either an in-person weight loss program, a video-conference delivered weight loss program, or to a usual care control group. We hypothesize that, compared to usual care, 30% more persons in each of the active arms will have a clinically significant weight loss (e2 kg) at 6-months, and will maintain this weight loss a 12-months. Attendance and intervention costs will be compared between intervention arms and cost-effectiveness will be estimated for all three study arms. This work could result in an effective and accessible weight loss intervention that could be widely and rapidly disseminated through CHCs and broadband Internet. PUBLIC HEALTH RELEVANCE: This project will test whether twice-weekly weight loss classes delivered either in-person or via video-conference lead to greater weight loss than usual care. Participants will be obese, middle-aged patients of community health centers. Classes consist of progressive exercise and nutrition education designed for a population with a range of literacy and numeracy skills.

描述（由申请人提供）：医学研究所将确定有效治疗高危人群（例如城市贫困人口）的有效方法的重中之重。社区卫生中心（CHC）为人提供初级保健，无论付款能力如何，在医疗保健改革下，将为大部分城市贫困人口提供护理。迄今为止，最有效的减肥干预措施经常进行员工与患者的互动，出勤率高和体育锻炼。这种密集的干预措施是CHC的挑战，因为它们长期较短，空间有限。而且，CHC患者的运输通常有限。视频会议需要很少的CHC空间，并且可能会减少员工的时间和患者的运输需求。单个员工可以为几乎任何地方的患者开会会议。尽管基于宽带互联网的低收入人群建立干预似乎是违反直觉的，但在大多数城市地区都可以使用宽带。此外，2010年3月17日，FCC向国会提供了一项为期10年的国家宽带计划，将高速互联网带到美国90％的房屋。我们已经成功地驾驶了一项多方视频会议减肥计划，该计划使用该项目提供的简单硬件和互联网访问向CHC患者提供了。我们已经使用了针对肥胖CHC患者的锻炼方案，以及为参与者群体修改的良好的营养教育和支持材料，包括识字率低和算术技能的人。对于拟议的疗效试验，我们将对人体质量指数E30和<50的150名成年CHC患者随机，以进行面对面的减肥计划，视频会议提供的减肥计划或通常的护理对照组。我们假设，与通常的护理相比，每个主动臂中的30％的人将在6个月时具有临床上显着的体重减轻（E2 kg），并且将使这种体重减轻为12个月。将对所有三个研究组的干预组和成本效益之间进行比较。这项工作可能会导致有效且可及的减肥干预措施，可以通过CHC和宽带互联网广泛而迅速地传播。 公共卫生相关性：该项目将测试每周两次减肥课程是否与视频会议交付会导致体重减轻，从而比平常的护理更大。参与者将是社区卫生中心的肥胖，中年患者。课程包括渐进式运动和营养教育，专为具有一系列识字和算术技能的人群而设计。