Increasing Access to USPSTF-Recommended Obesity Care for Youth and Adults Who Are Recipients of Medicaid: Evaluation of a Comprehensive Multidisciplinary Obesity Care Training Program in FQHCs

增加获得 USPSTF 建议的医疗补助青少年和成人肥胖护理的机会：对 FQHC 综合性多学科肥胖护理培训计划的评估

• 批准号: 10737453
• 负责人: Sarah Elizabeth Hampl
• 金额: $ 71.27万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10737453
• 关键词: Address; Adoption; Adult; Affect; Affordable Care Act; Behavior Therapy; Body Weight Changes; Body Weight decreased; Caring; Child; Clinic; Clinical; Cluster randomized trial; Communities; Community Health Aides; Competence; Counseling; Data; Detection; Diagnosis; Dietitian; Discipline; Disease; Education; Effectiveness; Electronic Health Record; Eligibility Determination; Equity; Evaluation; Evidence based treatment; Federally Qualified Health Center; Future; Health; Health Personnel; Health Policy; Health Services Accessibility; Health system; Inequity; Infrastructure; Intervention; Learning; Life Expectancy; Link; Low income; Maintenance; Medicaid; Medical; Methods; Missouri; National Institute of Diabetes and Digestive and Kidney Diseases; Non-Insulin-Dependent Diabetes Mellitus; Nutritionist; Obesity; Obesity Epidemic; Outcome; Patient Care; Patients; Perception; Phase; Policies; Population; Preventive service; Provider; Quality of Care; Quality of life; Randomized, Controlled Trials; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Research; Research Personnel; Rural Community; Savings; Services; Training; Training Programs; Translations; United States Preventative Services Task Force; Weight; Work; Youth; adult obesity; arm; behavioral health; care coordination; care fragmentation; clinically significant; cohort; community clinic; community setting; contextual factors; digital technology; disability; effectiveness/implementation design; evidence base; gaps in access; health care service utilization; health inequalities; implementation barriers; implementation outcomes; implementation strategy; improved; innovation; marginalized population; multidisciplinary; obese patients; obesity in children; obesity treatment; payment; population health; primary care provider; programs; recruit; rural area; screening; service delivery; social; social health determinants; social stigma; socioeconomics; urban area; Address; Adoption; Adult; Affect; Affordable Care Act; Behavior Therapy; Body Weight Changes; Body Weight decreased; Caring; Child; Clinic; Clinical; Cluster randomized trial; Communities; Community Health Aides; Competence; Counseling; Data; Detection; Diagnosis; Dietitian; Discipline; Disease; Education; Effectiveness; Electronic Health Record; Eligibility Determination; Equity; Evaluation; Evidence based treatment; Federally Qualified Health Center; Future; Health; Health Personnel; Health Policy; Health Services Accessibility; Health system; Inequity; Infrastructure; Intervention; Learning; Life Expectancy; Link; Low income; Maintenance; Medicaid; Medical; Methods; Missouri; National Institute of Diabetes and Digestive and Kidney Diseases; Non-Insulin-Dependent Diabetes Mellitus; Nutritionist; Obesity; Obesity Epidemic; Outcome; Patient Care; Patients; Perception; Phase; Policies; Population; Preventive service; Provider; Quality of Care; Quality of life; Randomized, Controlled Trials; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Research; Research Personnel; Rural Community; Savings; Services; Training; Training Programs; Translations; United States Preventative Services Task Force; Weight; Work; Youth; adult obesity; arm; behavioral health; care coordination; care fragmentation; clinically significant; cohort; community clinic; community setting; contextual factors; digital technology; disability; effectiveness/implementation design; evidence base; gaps in access; health care service utilization; health inequalities; implementation barriers; implementation outcomes; implementation strategy; improved; innovation; marginalized population; multidisciplinary; obese patients; obesity in children; obesity treatment; payment; population health; primary care provider; programs; recruit; rural area; screening; service delivery; social; social health determinants; social stigma; socioeconomics; urban area

Obesity in adults and children is associated with severe disease and poor quality of life, and disproportionately impacts rural communities and historically marginalized groups. Increased access to quality obesity care is an important strategy for reducing obesity-related inequities. The US Preventive Services Task Force (USPSTF) recommends primary care providers (PCPs) screen children and adults for obesity and offer or refer to comprehensive, intensive behavioral interventions (IBTs); however, these recommendations are rarely implemented. Lack of training for both PCPs and behavioral health providers (BHPs) is a major barrier to implementation of USPSTF-care. Other key barriers include workforce challenges, care fragmentation, clinician weight bias, limited clinic-community linkages, and patient-level socioeconomic barriers. Harnessing an upcoming Medicaid policy change, our team developed a scalable implementation strategy, Comprehensive Multidisciplinary Obesity Care (CMOC). We propose to train a collaborative team (i.e., PCPs, BHPs, Registered Dietitian Nutritionists, and community health workers) to implement USPSTF-care in Federally Qualified Health Centers (FQHCs). CMOC is an innovative approach that leverages policy supports, clinic-community linkages, and digital technology, and employs a comprehensive, multi-level training program addressing structural and systemic contributors (e.g., clinician weight bias) to health inequities to improve weight-related outcomes and sustain impact. Using an effectiveness-implementation design with a cluster randomized controlled trial (RCT) phase and a one-way crossover phase, 20 FQHCs in urban and rural areas of Missouri including ~100 PCPs and ~6,000 benefit-eligible patients (i.e., Medicaid recipients with obesity) will be assigned to CMOC or an implementation as usual control (IAUC) condition. CMOC includes provider training in obesity care competencies (e.g., weight bias reduction, structural competency), discipline-specific USPSTF-care, and learning collaboratives over 12 months, followed by a 12-month sustainability period. The one-way crossover phase implements CMOC in the control arm (following their participation in IAUC) over 12 months. Both phases include evaluations at 12- and 24-months post-training. To improve health outcomes among historically marginalized groups, our proposed study evaluates short- and long-term clinical and implementation outcomes of CMOC compared to IAUC using RE-AIM. Four aims will guide this work. Aim 1 compares patient-level effectiveness (i.e., patient relative weight change (1a) and the proportion of patients who achieve clinically significant weight loss (1b)). Aim 2 compares reach (patient treatment utilization). Aim 3 compares PCP referrals to care at 12 (adoption; 3a) and 24 months (maintenance; 3b), and short- and long-term changes in provider obesity care competencies (3c). Aim 4 compares implementation and service costs. In line with NIDDK Strategic Priorities, our project seeks to advance implementation of evidence-based care in communities, ultimately expanding access to promote equity and the right to a future without disability and disease for those most in need.

成人和儿童的肥胖与严重疾病和生活质量差有关，并且不成比例 影响农村社区和历史边缘化群体。增加获得优质肥胖护理的机会是 减少与肥胖相关的不平等的重要策略。美国预防服务工作队（USPSTF） 推荐初级保健提供者（PCP）筛选肥胖儿童和成人，并提供或参考 全面，密集的行为干预措施（IBTS）；但是，这些建议很少 实施的。缺乏针对PCP和行为健康提供商（BHP）的培训是一个主要障碍 USPSTF-Care的实施。其他关键障碍包括劳动力挑战，护理分裂，临床医生 体重偏见，有限的诊所社区联系和患者级的社会经济障碍。利用一个 即将进行的医疗补助政策变更，我们的团队制定了可扩展的实施策略，全面 多学科肥胖护理（CMOC）。我们建议培训一个协作团队（即PCP，BHPS，已注册 营养师营养学家和社区卫生工作者）在联邦合格的健康中实施USPSTF护理 中心（FQHC）。 CMOC是一种创新的方法，利用政策支持，诊所社区联系， 和数字技术，并采用了一个全面的多层次培训计划，以解决结构和 系统性贡献者（例如，临床医生体重偏见）对健康不平等，以改善与体重相关的结果和 维持影响。使用群集随机对照试验（RCT）使用有效性实施设计 阶段和一个单向跨界阶段，密苏里州城市和农村地区的20个FQHC，包括约100个PCP 约有6,000名符合福利资格的患者（即，肥胖症的医疗补助接受者）将分配给CMOC或 像往常一样执行（IAUC）条件。 CMOC包括肥胖护理能力的提供者培训 （例如，减轻体重偏见，结构能力），特定于纪律的USPSTF和学习 在12个月内的合作活动，其次是12个月的可持续性期。单向跨界阶段 在12个月内，将CMOC在对照组中（在参加IAUC之后）。两个阶段都包括 训练后12个月和24个月的评估。改善历史上边缘化的健康状况 我们建议的研究小组评估了CMOC的短期和长期临床和实施结果 与使用re-aim相比。四个目标将指导这项工作。 AIM 1比较患者级的效率 （即患者相对体重变化（1A）和达到临床重量显着的患者比例 损失（1b））。 AIM 2比较覆盖范围（患者治疗利用）。 AIM 3比较了PCP转介到12时的护理 （收养； 3A）和24个月（维护； 3b），以及提供者肥胖护理的短期和长期变化 能力（3C）。 AIM 4比较实施和服务成本。符合NIDDK的战略重点， 我们的项目旨在提高在社区中实施基于证据的护理，最终扩大 获得公平和未来的权利，而没有残疾和疾病，最需要的人。