Testing the Efficacy of a Technology-Assisted Weight Management Intervention within Patient-Centered Medical Homes: The GEM (Goals for Eating and Moving) Study

测试以患者为中心的医疗之家中技术辅助体重管理干预措施的功效：GEM（饮食和运动目标）研究

• 批准号: 9355177
• 负责人: Melanie Jay
• 金额: $ 74.51万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-20 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9355177
• 关键词: Address; Adopted; Adoption; Adult; Advisory Committees; Appointment; Attitude; Body Weight Changes; Body Weight decreased; Body mass index; Caring; Clinical; Comorbidity; Competence; Computer software; Control Groups; Counseling; Data; Eating; Educational Materials; Effectiveness; Eligibility Determination; Enrollment; Evaluation; Future; Glycosylated hemoglobin A; Goals; Health; Health Promotion; Health system; Healthcare Systems; Home environment; Hyperlipidemia; Hypertension; Individual; Intake; Intervention; Licensing; Life Style; Lipids; Maintenance; Medical; Medical Care Team; Medical center; Medicare; Modeling; Monitor; Motivation; New York; Obesity; Outcome; Patient Education; Patient-Centered Care; Patients; Physical activity; Preventive service; Primary Health Care; Process; Provider; Randomized; Randomized Controlled Trials; Recruitment Activity; Self Efficacy; Services; Site; Structure; Tablet Computer; Technology; Telephone; Testing; Time; Transportation; United States; Urban Health; Veterans; Visit; Weight; Weight maintenance regimen; Work; arm; base; behavior change; behavioral outcome; blood pressure reduction; cardiometabolic risk; design; diabetes prevention program; diabetes risk; disorder prevention; efficacy testing; evidence base; follow-up; fruits and vegetables; group intervention; improved; innovative technologies; intervention program; lifestyle intervention; novel; obesity treatment; patient oriented; patient population; population health; primary care setting; primary outcome; programs; randomized trial; therapy design; tool; treatment as usual; waist circumference

PROJECT SUMMARY The United States Preventive Services Task Force (USPSTF) recommends that primary care providers use the 5As framework (Assess, Advise, Agree, Assist, Arrange) to provide counseling to obese patients. Providers frequently do not counsel patients due to barriers such as competing demands and low perceived competency which may contribute to poor patient attendance to effective weight management programs. Patient-centered medical homes can use team-based care to address these barriers, increase attendance to intensive weight management programs, and provide weight management services to those who do not to attend. We developed and formatively evaluated an innovative, technology-assisted 5As-based intervention to promote weight loss, behavior change, and increase enrollment in intensive programs (e.g. the MOVE! program from the Veteran’s Affairs (VA) and the Diabetes Prevention Program) within medical homes. This intervention, called GEM (Goals for Eating and Moving), uses 4 components to deliver 5As counseling—the GEM online tool, health coach counseling, brief primary care team counseling, and follow-up telephone coaching. The GEM tool is a mobile-friendly software program delivered via tablet computers in the primary care setting to facilitate counseling by a health coach and primary care staff. Our preliminary data suggest that the GEM intervention is feasible and acceptable to patients and staff and facilitates 5As counseling. A randomized trial is needed to examine its impact on weight loss and health outcomes. We will conduct a cluster-randomized controlled trial at 2 urban health centers: the VA New York Harbor and at sites within the Montefiore Medical Group (MMG) to assess the efficacy of the GEM intervention compared to Enhanced Usual Care. We will recruit 512 patients from 16 primary care teams (8 from VA sites, 8 from MMG sites), each with 2 or more primary care providers. Eligible patients with a Body Mass Index of ≥30 kg/m2 or >25 kg/m2 and comorbidities with upcoming primary care appointments will be recruited via mail with follow up telephone calls. Patients within primary care teams randomized to the intervention group will receive the GEM intervention and those in the control group will receive Enhanced Usual Care. The primary outcome will be weight loss at the end of the 1 year intervention. We will use the RE-AIM evaluation framework to assess the reach (proportion of eligible patients who enroll), efficacy (weight loss and other related outcomes), adoption (acceptability to primary care teams), implementation (intervention fidelity) and maintenance (sustainability of weight change and program components between 12 and 24 months post-randomization).

项目摘要 美国预防服务工作队（USPSTF）建议初级保健提供者使用 5AS框架（评估，建议，同意，协助，安排）为肥胖患者提供咨询。提供者 由于障碍（例如竞争需求和较低的感知能力），通常不建议患者咨询患者 这可能导致患者参加有效的体重管理计划不佳。以患者为中心 医疗住宅可以使用基于团队的护理来解决这些障碍，增加出勤率到大量体重 管理计划，并为不参加的人提供体重管理服务。我们 开发并形成了一种创新的，技术辅助的基于5A的干预措施，以促进 体重减轻，行为改变并增加密集计划的入学率（例如，从 在医疗之家中的退伍军人事务（VA）和糖尿病预防计划）。这种干预措施，称为 宝石（饮食和移动目标），使用4个组件提供5AS咨询 - 宝石在线工具， 健康教练咨询，简短的初级保健团队咨询和后续电话教练。宝石工具 是通过在初级保健环境中通过平板电脑提供的移动友好软件程序，以促进 由健康教练和初级保健人员的咨询。我们的初步数据表明，宝石干预是 患者和员工的可行和可接受，并促进5A咨询。需要一个随机试验 检查其对体重减轻和健康结果的影响。我们将进行集群随机对照试验 位于2个城市卫生中心：弗吉尼亚州纽约港和蒙特菲奥尔医疗集团（MMG）的地点 与增强的常规护理相比，评估宝石干预的效率。我们将招募512名患者 来自16个初级保健团队（来自VA站点的8个，来自MMG站点的8个），每个部门有2个或更多的初级保健提供者。 体重指数≥30kg/m2或> 25 kg/m2的合格患者且合并症即将到来 护理约会将通过邮件和后续电话招募。初级保健团队中的患者 随机分配到干预组将接受GEM干预，对照组的人将 接受增强的常规护理。主要结果是在1年干预结束时体重减轻。 我们将使用Re-AIM评估框架评估覆盖范围（符合条件的患者比例）， 效率（减肥和其他相关结果），采用（对初级保健团队的可接受性）， 实施（干预保真度）和维护（体重变化的可持续性和计划的可持续性 随机化后12到24个月之间的组成部分）。