Reach, Outcomes and System Impacts of the VA's National Weight Loss Program, MOVE

退伍军人管理局国家减肥计划 MOVE 的范围、成果和系统影响

• 批准号: 8878249
• 负责人: LAWRENCE S PHILLIPS
• 金额: $ 16.03万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-01 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8878249
• 关键词: Address; Affect; Age; Algorithms; American; Area; Behavior Therapy; Blood Pressure; Body Weight decreased; Cardiovascular Diseases; Caring; Characteristics; Clinical; Communities; Comorbidity; Data; Data Set; Databases; Development; Diabetes Mellitus; Diabetes prevention; Effectiveness; Electronic Health Record; Eligibility Determination; Enrollment; Environment; Epidemic; Equation; Ethnic Origin; Event; Future; Gender; Glucose; Health; Health Professional; Health Status; Health system; Healthcare; Healthcare Systems; High Performance Computing; Incidence; Individual; Informatics; Inpatients; Intervention; Knowledge; Learning; Life Style; Lipids; Modeling; Motivation; Obesity; Outcome; Outpatients; Overweight; Participant; Patients; Performance; Pharmaceutical Preparations; Pharmacy facility; Primary Health Care; Provider; Public Health; Race; Recommendation; Research; Research Infrastructure; Resources; Risk Factors; Secure; System; Testing; Time; Veterans; Weight; Wit; Work; base; cardiometabolic risk; cardiovascular disorder risk; cardiovascular risk factor; clinical care; clinically significant; combat; cost; cost effective; diabetes management; diabetes prevention program; ethnic minority population; health disparity; health economics; improved; intervention program; lifestyle intervention; meetings; non-diabetic; programs; public health relevance; racial and ethnic; stem; tool; volunteer; willingness

DESCRIPTION (provided by applicant): Lifestyle modification is urgently recommended to combat obesity and diabetes, yet very little is known about the implementation of large-scale lifestyle change programs in real-world clinical settings. The VA's MOVE program is the largest lifestyle change program nationwide, with over 400,000 participants since 2005. We will address three Aims: (1) To determine the extent to which disparities affect enrollment and participation in MOVE; (2) To determine the extent to which participation in MOVE improves cardio-metabolic risk; and (3) To determine the impact of participation on healthcare system resource use and costs. National data are available from the VA's Corporate Data Warehouse, and analyses will be conducted using SAS within the VA Informatics and Computing Infrastructure (VINCI), a high-performance secure computing environment. Veterans who meet eligibility criteria for MOVE participation, with at least 3 consecutive years of VA primary care from 2005 to 2012, will be included. Multiple modeling strategies, including generalized estimating equations, will be used to appropriately analyze longitudinal data. This research has the potential to profoundly impact the field of diabetes prevention. Expected results include groundbreaking knowledge of a national, clinically-based program's reach and impact on patient health and the health system. The work is unique in several key areas: (1) MOVE is the largest weight loss program nationwide; (2) MOVE is implemented within a clinical setting, unlike more common community-based approaches; (3) MOVE is a real-world program in which participants are patients recommended for weight loss by their primary care providers, rather than "study volunteers"; (4) the proposed research examines MOVE's impacts on both individual-level health outcomes and health system-level costs and resource use. While outcomes are expected to be more modest in MOVE than in the Diabetes Prevention Program (DPP), preliminary data indicate that MOVE participation substantially reduces diabetes incidence. The proposed work will examine improvements in BMI, CVD risk factors, diabetes and CVD incidence, medication usage, and health system costs and resource use. This research will also inform future work, such as an expected-benefits algorithm and EHR tool to provide healthcare professionals and patients with individualized recommendations. Nearly three quarters of veterans in the VA health system are overweight or obese; thus, approximately 6 million veterans stand to benefit from MOVE if it is found to be effective. In addition to evaluating the program's health and health system impacts, the proposed research will inform improvements in MOVE implementation by identifying disparities in program participation as well as provider- and facility-level factors associated wit reduced disparities. This work is also relevant outside of the VA, as lessons learned from these analyses will inform other health care systems where many more millions of Americans could benefit from lifestyle change programs similar to MOVE.

描述（由申请人提供）：迫切建议对生活方式进行修改以抗击肥胖和糖尿病，但对于在现实临床环境中实施大规模生活方式改变计划的实施知之甚少。 VA的搬家计划是全国最大的生活方式改变计划，自2005年以来，有超过40万名参与者。我们将解决三个目标：（1）确定差异影响入学和参与的程度 移动; （2）确定参与运动的程度可改善心脏代谢风险； （3）确定参与对医疗系统资源使用和成本的影响。可以从VA的公司数据仓库中获得国家数据，并将使用VA信息学和计算基础架构（VINCI）（VINCI）内的SAS进行分析，这是一个高性能的安全计算环境。符合搬迁参与资格标准的退伍军人将包括2005年至2012年至少连续3年的VA初级保健。多个建模策略（包括广义估计方程）将用于适当分析纵向数据。 这项研究有可能深刻影响预防糖尿病领域。预期的结果包括对国家基于临床的计划的开创性知识以及对患者健康和卫生系统的影响。这项工作在几个关键领域是独一无二的：（1）移动是全国最大的减肥计划； （2）与更常见的基于社区的方法不同，移动是在临床环境中实施的； （3）移动是一个现实世界中的计划，其中参与者是由其初级保健提供者建议减肥的患者，而不是“研究志愿者”； （4）拟议的研究研究了Move对个人水平健康成果以及卫生系统级成本和资源使用的影响。虽然预计结果比预防糖尿病计划（DPP）更为适中，但初步数据表明，移动参与大大降低了糖尿病的发病率。拟议的工作将研究BMI，CVD风险因素，糖尿病和CVD发病率，用药以及卫生系统成本和资源使用的改善。这项研究还将为未来的工作提供信息，例如预期的效益算法和EHR工具，可为医疗保健专业人员和患者提供个性化建议。 VA卫生系统中近四分之三的退伍军人超重或肥胖。因此，如果发现有效的话，大约有600万退伍军人将从移动中受益。除了评估该计划的健康和卫生系统影响外，拟议的研究还将通过确定计划参与的差异以及提供者和设施级别的因素降低差异来为改进移动实施提供了帮助。这项工作在VA之外也很重要，因为从这些分析中学到的经验教训将为其他医疗保健系统提供信息，其中数百万美国人可以从类似于移动的生活方式改变计划中受益。