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）：迫切建议改变生活方式以对抗肥胖和糖尿病，但人们对在现实世界临床环境中实施大规模生活方式改变计划知之甚少。 VA 的 MOVE 计划是全国最大的生活方式改变计划，自 2005 年以来已有超过 400,000 名参与者。我们将实现三个目标：(1) 确定差异对入学和参与的影响程度 移动; (2) 确定参与 MOVE 在多大程度上改善了心脏代谢风险； (3) 确定参与对医疗保健系统资源使用和成本的影响。国家数据可从 VA 的企业数据仓库获取，分析将在 VA 信息学和计算基础设施 (VINCI)（一种高性能安全计算环境）内使用 SAS 进行。符合 MOVE 参与资格标准、2005 年至 2012 年至少连续 3 年接受 VA 初级护理的退伍军人将被纳入其中。将使用多种建模策略（包括广义估计方程）来适当分析纵向数据。 这项研究有可能对糖尿病预防领域产生深远的影响。预期结果包括对国家临床计划的影响范围以及对患者健康和卫生系统的影响的开创性了解。这项工作在几个关键领域是独一无二的：（1）MOVE是全国最大的减肥计划； (2) MOVE 是在临床环境中实施的，与更常见的基于社区的方法不同； （3）MOVE是一个现实世界的项目，参与者是初级保健提供者推荐减肥的患者，而不是“研究志愿者”； (4) 拟议的研究考察了 MOVE 对个人层面的健康结果以及卫生系统层面的成本和资源使用的影响。虽然 MOVE 的结果预计比糖尿病预防计划 (DPP) 的效果要温和，但初步数据表明，MOVE 的参与大大降低了糖尿病的发病率。拟议的工作将研究体重指数、CVD 危险因素、糖尿病和 CVD 发病率、药物使用以及卫生系统成本和资源使用方面的改善情况。这项研究还将为未来的工作提供信息，例如预期效益算法和 EHR 工具，为医疗保健专业人员和患者提供个性化建议。 退伍军人管理局医疗系统中近四分之三的退伍军人超重或肥胖；因此，如果发现 MOVE 有效，大约 600 万退伍军人将从中受益。除了评估该计划对健康和卫生系统的影响外，拟议的研究还将通过确定计划参与方面的差异以及与减少差异相关的提供者和设施层面的因素，为 MOVE 实施的改进提供信息。这项工作在 VA 之外也具有相关性，因为从这些分析中吸取的经验教训将为其他医疗保健系统提供信息，使更多的数百万美国人可以从类似于 MOVE 的生活方式改变计划中受益。