Measuring the Longitudinal Relationshipsbetween Obesity, Weight Management Intervention, and Medical Expenditure

测量肥胖、体重管理干预和医疗支出之间的纵向关系

• 批准号: 10759361
• 负责人: MATTHEW L MACIEJEWSKI
• 金额: --
• 依托单位: DURHAM VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-06-01 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10759361
• 关键词: Address; Adoption; Adult; Affect; Algorithms; Behavior Therapy; Behavioral; Big Data; Body Weight decreased; Body mass index; Businesses; Caring; Characteristics; Clinical; Complement component C4; Coronary heart disease; Counseling; Data Sources; Degenerative polyarthritis; Disease; Economics; Effectiveness; Eligibility Determination; Expenditure; Goals; Health; Health Expenditures; Health Promotion; Healthcare; Hypertension; Individual; Informatics; Intervention; Lead; Life Style; Longitudinal trends; Measures; Medical; Morbid Obesity; Natural History; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Outcome; Overweight; Patient-Centered Care; Patients; Pattern; Pharmacotherapy; Policy Analysis; Population; Prevalence; Research; Resources; Risk; Running; Strategic Planning; Subgroup; Systems Integration; Validation; Veterans; Weight; Weight Gain; Weight maintenance regimen; bariatric surgery; clinical risk; disorder prevention; economic evaluation; economic impact; economic outcome; experience; follow-up; improved; improved outcome; machine learning method; obese patients; obesity risk; obesity treatment; population based; population health; preventable death; programs; research clinical testing; symposium; treatment effect; trend; weight loss intervention

The prevalence of obesity among adults is stabilizing after decades of unrelenting increases and about 68% of Veterans are considered either overweight or obese. Obesity is the second leading cause of preventable deaths in the US and is associated with a wide range of diseases, such as hypertension, type 2 diabetes mellitus, coronary heart disease, and osteoarthritis. These clinical risks lead obese patients to incur disproportionately high health expenditures. In 2008, annual health expenditures attributable to obesity were estimated to be $147 billion, concentrated among morbidly obese patients. In 2013, 28.2% of overall health expenditures for adults was incurred for obesity-associated care. Currently, three types of weight management interventions are available to overweight and obese VA patients: behavioral lifestyle counseling, pharmacotherapy and bariatric surgery. The most widely used of these interventions is behavioral counseling through the MOVE! program. Despite the widespread adoption of MOVE! as a first line treatment for obesity in VA, MOVE! participation has been associated with modest short- term weight loss and evidence is absent regarding the clinical and economic effectiveness of MOVE! beyond a 12-month follow-up. No prior VA studies have examined the natural history of weight gain, long-term expenditures of normal weight, overweight and obese Veterans, or changes in weight and expenditures attributable to MOVE!. It is important to understand longitudinal (20-year) patterns of VA healthcare expenditures by BMI progression to characterize the long-run scope of the problem of obesity in VA. Such results will then provide significant context for evaluating the health and economic effectiveness of MOVE! participation. Taken together, the four specific aims will enable an examination of impact of MOVE! on Veteran outcomes in the context of VA's overall population-level weight management strategy on eligible Veterans: Aim 1: Identify latent classes of different BMI progression trajectories between 2000-2019. Aim 2: Estimate differences in long term VA expenditures between latent BMI classes. Aim 3: Identify the average treatment effect of MOVE! and characteristics of Veterans who experience the greatest weight reductions following MOVE! participation. Aim 4: Identify the average treatment effect of MOVE! on expenditures and characteristics of Veterans who experience the greatest reduction in VA expenditures following MOVE! participation. Next Steps: The examination of 20-year expenditures associated with obesity and differential effects of MOVE! responds to one of the top four strategic goals identified in the VA FY 2018-2024 Strategic Plan by informing approaches to focus resources more efficiently. This study also addresses HSR&D's cross-cutting priority of business case and policy analysis and the Healthcare Informatics priority through the analysis, validation, and application of Big Data sources to improve individual and population health. This research will also enable us to formalize an algorithm to identify patients most likely to benefit from MOVE!, as well as those unlikely to achieve significant clinical weight loss through MOVE!. Following identification of Veterans at greatest risk for obesity and high VA expenditures, and of Veterans who experience the greatest weight and expenditure improvements following weight loss intervention, we will partner with NCP to determine how best to implement a prioritization strategy to develop need-tailored behavioral programs.

成年人肥胖的患病率是在数十年来的不懈增加之后稳定的 68％的退伍军人被认为是超重或肥胖。肥胖是第二个主要原因 美国可预防的死亡，与多种疾病有关，例如高血压，类型2 糖尿病，冠心病和骨关节炎。这些临床风险导致肥胖患者发生 不成比例的健康支出。 2008年，可归因于肥胖的年度健康支出是 估计为1470亿美元，集中在病态肥胖患者中。 2013年，整体健康状况的28.2％ 成人的支出是针对肥胖相关的护理而产生的。 目前，可以使用三种类型的体重管理干预措施来超重和肥胖的VA 患者：行为生活方式咨询，药物治疗和减肥手术。最广泛使用的 这些干预措施是通过举动进行行为咨询！程序。尽管采用了广泛的采用 移动！作为VA肥胖症的第一行治疗，请移动！参与与适度的短暂相关 对于移动的临床和经济有效性，缺乏定期体重减轻和证据！超越一个 12个月的随访。没有先前的VA研究检查体重增加的自然历史，长期 体重正常，超重和肥胖的退伍军人或体重和支出变化的支出 归因于移动！了解VA Healthcare的纵向（20年）模式很重要 BMI进展的支出以表征VA肥胖问题的长期范围。这样的 然后，结果将为评估移动的健康和经济有效性提供重要背景！ 参与。综上所述，四个特定目标将能够检查移动的影响！在退伍军人上 在VA的整体人口水平体重管理策略上，成果是合格退伍军人的： 目标1：在2000 - 2019年之间确定不同BMI进展轨迹的潜在类别。 目标2：估计潜在BMI类之间长期VA支出的差异。 目标3：确定移动的平均治疗效果！和经验丰富的退伍军人的特征 移动后重量减轻！参与。 目标4：确定移动的平均治疗效果！关于退伍军人的支出和特征 移动后，体验VA支出的最大减少！参与。 下一步：检查与肥胖和差异影响的20年支出的检查 移动！响应在2018 - 2024财年在2018-2024战略计划中确定的前四个战略目标之一。 告知方法以更有效地集中资源。这项研究还涉及HSR＆D的横切 通过分析的业务案例和政策分析的优先级以及医疗保健信息学优先级， 验证和大数据源以改善个人和人口健康。这项研究会 还使我们能够正式化算法来识别最有可能从移动中受益的患者，以及 不太可能通过移动实现重大的临床体重减轻！在确定退伍军人之后 肥胖和高VA支出的最大风险，以及经历最大体重和最大的退伍军人 减肥干预后的支出改进，我们将与NCP合作，以确定如何最好 实施优先级策略来制定需求的行为计划。