Managing Obesity by Leveraging Health Information Technology to Lower Cancer Risk

利用健康信息技术控制肥胖以降低癌症风险

基本信息

批准号：
10355938
负责人：
KAREN C JOHNSON
金额：
$ 63.91万
依托单位：
UNIVERSITY OF TENNESSEE HEALTH SCI CTR
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-01-14 至 2026-12-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10355938
关键词：
Address Adult Affect Area Behavior Therapy Behavioral Body Weight Changes Body Weight decreased Caring Clinical Practice Guideline Clinical Trials Communities Diabetes Mellitus Diet Disease Effectiveness Electronic Health Record Enrollment Funding Goals Group Practice Guidelines Health Health Personnel Health Sciences Healthcare Systems Incidence Intervention Intervention Studies Low income Malignant Neoplasms Medical Methodist Church Methods Minority Groups Modeling Obesity Obesity associated cancer Outcome Overweight Participant Patients Persons Physical activity Physicians Population Population Group Private Sector Protocols documentation Public Sector Randomized Randomized Clinical Trials Research Research Personnel Research Project Grants Research Proposals Resources Risk Risk Factors Rural Population Site Support System System Target Populations Technology Telephone Tennessee Testing Time Touch sensation Training Translating Underserved Population United States United States National Institutes of Health Universities Weight Gain Weight maintenance regimen Work adult obesity base behavior change cancer risk cancer type clinical practice comparison group comparison intervention cost effective ethnic minority population formative assessment group intervention health care availability health disparity health information technology health plan healthcare community healthy lifestyle high risk innovation lifestyle intervention low socioeconomic status minority health disparity obesity management obesity risk obesity treatment patient health information patient portal prevent primary care setting primary outcome racial and ethnic racial minority rural area rural setting social social health determinants socioeconomics success tool uptake urban area urban setting weight loss intervention weight loss program

项目摘要

Obesity is an important risk factor for many serious diseases including many types of cancer.2-36 In the United States, obesity disproportionally affects underserved population groups such as racial and ethnic minorities, persons with lower socioeconomic status, and persons living in rural areas.1,37,38 These underserved groups are also at increased risk for developing and dying from cancer.39-42 Large clinical trials, such as Look AHEAD (Action for Health in Diabetes), have shown that a multicomponent weight loss intervention combining diet, physical activity, and behavioral modification is effective in achieving long term weight loss which resulted in a lower incidence of obesity-related cancers.43-45 As a result, clinical practice guidelines recommend the delivery of obesity interventions in primary care settings. However, it is unknown if such weight loss interventions work well in underserved populations or in rural settings because of limited access to healthcare resources and community facilities for a healthy lifestyle and/or because the target population may have different cultural and social backgrounds. To overcome these specific barriers to implementing a weight loss intervention, we propose a practice- based clinical trial to translate the efficacious Look AHEAD Intensive Lifestyle Intervention (ILI) to underserved populations. In this project, we will modify the intervention to be delivered through Health IT specifically the patient portal in the electronic health record (EHR) and will work with the Methodist Medical Group to establish partnerships between the investigators and community stakeholders. This project tests whether the Look AHEAD Intensive Lifestyle Intervention (ILI) will result in significant weight loss when delivered through Health IT- EHR patient portal compared to a Comparison intervention. This project will be conducted in 2 stages: a formative assessment stage (Stage 1) and a clinical trial stage (Stage 2). During Stage 1, we will modify the interactive technology-based Look AHEAD ILI that we already developed for the TARGIT study (Active Intervention Group). We will also adapt the Look AHEAD Comparison condition (DSE group) for our Comparison condition.56 We will also optimize the protocol for acceptability in underserved populations and in a rural setting. During Stage 2, we will randomly assign 250 participants to either the Comparison Group or the Active Intervention Group to address the primary aim of testing the hypothesis that a multicomponent, behavioral weight loss intervention delivered through Health IT – EHR patient portal will lead to significantly greater weight loss 12 months after enrollment compared with a comparison group. Our Health IT-based intervention is potentially cost-effective and thus disseminable to any practice-based physician group with access to an EHR with a patient portal. We have chosen the Socio-ecological Model as our conceptual model to assist with understanding social determinants of health as related to the study intervention and weight loss.

肥胖是许多严重疾病（包括多种癌症）的重要危险因素。2-36 在美国，肥胖对服务不足的人口群体（例如种族和族裔）的影响尤为严重少数民族、社会经济地位较低的人和生活在农村地区的人。1,37,38 这些人服务不足群体患癌症和死于癌症的风险也增加。39-42 大型临床试验，例如 Look AHEAD（糖尿病健康行动）已表明，多成分减肥干预措施结合了饮食、体力活动和行为改变可有效实现长期减肥，从而导致肥胖相关癌症的发病率较低。43-45 因此，临床实践指南建议在初级保健机构中提供肥胖干预措施然而，尚不清楚这种减肥措施是否有效。由于获得医疗保健的机会有限，干预措施在服务不足的人群或农村地区效果良好健康生活方式的资源和社区设施和/或因为目标人群可能有不同的文化和社会背景。为了克服实施减肥干预措施的这些具体障碍，我们提出了一种做法：基于临床试验，将有效的 Look AHEAD 强化生活方式干预 (ILI) 应用于服务不足的地区在这个项目中，我们将修改通过健康 IT 提供的干预措施，特别是针对人群。电子健康记录 (EHR) 中的患者门户，并将与卫理公会医疗集团合作该项目测试是否在调查人员和社区利益相关者之间建立伙伴关系。展望未来，强化生活方式干预（ILI）将导致体重显着减轻健康 IT-EHR 患者门户网站与比较干预措施的比较该项目将在 2 年内进行。阶段：形成性评估阶段（第一阶段）和临床试验阶段（第二阶段）。修改我们已经为 TARGIT 研究开发的基于交互式技术的 Look AHEAD ILI （主动干预组）我们还将调整前瞻性比较条件（DSE 组）。比较条件。56 我们还将优化方案，使其在服务不足的人群中和在在第二阶段，我们将随机分配 250 名参与者到比较组或对照组。积极干预小组的主要目标是检验多组分、通过 Health IT – EHR 患者门户提供的行为减肥干预将带来显着的效果与基于 Our Health IT 的对照组相比，入组 12 个月后体重减轻幅度更大。干预措施具有潜在的成本效益，因此可以传播给任何以实践为基础的医师团体通过患者门户访问 EHR 我们选择社会生态模型作为我们的概念模型。帮助了解与研究干预和减肥相关的健康社会决定因素。