Testing the efficacy of a technology-assisted intervention to improve weight management of obese patients within Patient Aligned Care Teams at the VA

测试技术辅助干预措施的有效性，以改善退伍军人管理局患者协调护理团队中肥胖患者的体重管理

• 批准号: 9927908
• 负责人: Melanie Jay
• 金额: --
• 依托单位: VA NEW YORK HARBOR HLTHCARE/SYS/BROOKLYN
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-07-01 至 2021-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9927908
• 关键词: Address; Advisory Committees; Attitude; Behavior; Behavioral; Blood Pressure; Body Weight Changes; Body Weight decreased; Body mass index; Caring; Case Manager; Clinic; Clinical; Competence; Computer software; Continuity of Patient Care; Counseling; Data; Diabetes Mellitus; Diet; Enrollment; Ensure; Focus Groups; Frequencies; Glycosylated hemoglobin A; Goals; Health; Health Promotion; Health Services Research; Healthcare; Healthcare Systems; Home environment; Hyperlipidemia; Hypertension; Intake; Intervention; Interview; K-Series Research Career Programs; Life Style; Low-Density Lipoproteins; Medical center; Methods; Modeling; Monitor; Motivation; New York; Obesity; Outcome; Participant; Patient Education; Patients; Physical activity; Preventive service; Primary Health Care; Process; Provider; Qualitative Methods; Randomized; Randomized Controlled Trials; Schedule; Self Efficacy; Services; Shoulder; Site; Tablet Computer; Technology; Telephone; Testing; Time; Transportation; United States; United States Department of Veterans Affairs; Veterans; Visit; Weight maintenance regimen; Work; arm; base; behavior change; behavioral outcome; cardiometabolic risk; care providers; comorbidity; comparison intervention; design; disorder prevention; effectiveness trial; efficacy testing; follow-up; fruits and vegetables; group intervention; high risk; improved; informant; innovation; innovative technologies; multidisciplinary; novel; obesity management; obesity treatment; patient oriented; patient-level barriers; programs; randomized trial; research and development; therapy design; tool; treatment arm; treatment as usual; usability; usual care arm; waist circumference

Project Summary Abstract Project Background Veterans shoulder a disproportionate burden of obesity and its co-morbidities. The VA currently offers an effective weight management program called MOVE!, but the majority of eligible patients do not attend. Since Veterans see their primary care providers (PCPs) on average 3.6 times per year, the primary care (PC) visit is an important opportunity to counsel obese patients about weight management, especially patients who cannot or prefer not to attend the MOVE! program. However, since PCPs often fail to counsel patients, interventions are needed to facilitate weight management counseling within the PACT model of team-based care. Through HSR&D CDA study 10-206, we used rigorous qualitative methods (patient focus groups, key informant interviews with PACT staff, and usability testing of novel software) to develop the MTG intervention that integrates technology-assisted counseling by a health coach and PACT staff to deliver weight management counseling using the 5As framework (assess, advise, agree, assist, arrange) as recommended by the United States Preventive Services Task Force. Project Objectives The objectives of this study are to: (a) test the impact of the MTG intervention on weight change and behavioral/clinical outcomes; (b) identify predictors of weight loss in Veterans participating in the intervention group related to goal setting processes and intervention components; and (c) determine the impact of the MTG intervention on PACT obesity-related counseling practices and attitudes. Project Methods To achieve these objectives, we will conduct a cluster randomized controlled trial of PACTs (randomized at RN Care Manager level) and 392 of their obese Veteran patients at two VA sites (New York and Brooklyn campuses, NY Harbor Healthcare System) to study the impact of the 12-month MTG intervention when compared to Enhanced Usual Care. Patients in the MTG intervention will take the MTG tool, receive health coach counseling, go to their scheduled same-day PC visit, receive brief PACT counseling, and receive follow up telephone coaching from the health coach over 12 months. The MTG tool is a mobile-friendly software program designed to be delivered on tablet computers in the clinic setting to assess lifestyle behaviors and barriers, provide tailored advice and patient education materials, create initial weight loss and behavior change goals, and facilitate counseling by the health coach and PACT staff. Patients in the Enhanced Usual Care arm will receive patient education materials (standard VA Healthy Living Messages) and attend their scheduled same-day PC visit. All patient participants will attend follow-up visits at 3-, 6- and 12-months to assess Body Mass Index, waist circumference, diet and physical activity, and goal attainment. PACT staff and health coach outcomes will include 5As-related competency, as well as quality and frequency of counseling.

项目摘要摘要 项目背景 退伍军人承担着肥胖及其合并症的不成比例负担。 VA目前提供 有效的体重管理计划称为Move！，但大多数合格的患者不参加。自从 退伍军人每年平均看到他们的初级保健提供者（PCP），初级保健（PC）访问是 一个重要的机会，向肥胖患者提供体重管理，尤其是无法 或不愿意参加这一举动！程序。但是，由于PCP通常无法咨询患者，因此干预措施 需要在基于团队的护理的协议模型中促进体重管理咨询。通过 HSR＆D CDA研究10-206，我们使用了严格的定性方法（患者焦点小组，关键线人 对PACT人员的访谈以及对新软件的可用性测试），以开发MTG干预措施 整合健康教练和协定人员的技术协助咨询以提供体重管理 使用5AS框架（评估，建议，同意，协助，安排）的咨询 国家预防服务工作队。 项目目标 这项研究的目标是：（a）测试MTG干预对体重变化和 行为/临床结果； （b）确定参加干预的退伍军人体重减轻的预测指标 与目标设定过程和干预组件相关的小组； （c）确定MTG的影响 干预与肥胖有关的咨询实践和态度。 项目方法 为了实现这些目标，我们将进行公约的群集随机对照试验（随机分配 RN护理经理级别）和392名在两个VA站点（纽约和布鲁克林） 纽约港口医疗系统校园）研究12个月MTG干预的影响 与增强的通常护理相比。 MTG干预中的患者将采用MTG工具，接受健康 教练咨询，参加他们计划的当天PC访问，接受简短的协议咨询，并接受关注 在12个月内从健康教练那里掌握电话指导。 MTG工具是一种移动友好的软件 计划旨在在诊所环境中的平板电脑上交付，以评估生活方式行为和 障碍，提供量身定制的建议和患者教育材料，创造最初的体重减轻和行为改变 目标，并促进健康教练和协定人员的咨询。增强的常规护理臂中的患者 将收到患者教育材料（标准VA健康生活消息）并参加他们的计划 当日PC访问。所有患者参与者将参加3个，6个月和12个月的后续访问，以评估身体 质量指数，腰围，饮食和体育锻炼以及目标。协定员工和健康教练 成果将包括5AS相关的能力，以及咨询的质量和频率。