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

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，并且不成比例地与肥胖相关。 影响农村社区和历史上边缘化的群体。增加获得优质肥胖护理的机会是一个 减少与肥胖相关的不平等的重要战略。美国预防服务工作组 (USPSTF) 建议初级保健提供者 (PCP) 对儿童和成人进行肥胖筛查，并提供或参考 全面、强化的行为干预（IBT）；然而，这些建议很少被采纳 实施的。 PCP 和行为健康提供者 (BHP) 缺乏培训是实现这一目标的主要障碍 实施 USPSTF-care。其他主要障碍包括劳动力挑战、护理分散、临床医生 体重偏差、有限的诊所与社区联系以及患者层面的社会经济障碍。利用 即将到来的医疗补助政策变化，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、BHP、注册 营养师营养师和社区卫生工作者）在联邦合格健康中实施 USPSTF 护理 中心 (FQHC)。洛阳钼业是一种创新方法，利用政策支持、诊所与社区的联系、 和数字技术，并采用全面的、多层次的培训计划来解决结构和 健康不平等的系统性因素（例如临床医生体重偏差），以改善与体重相关的结果和 维持影响。使用有效性实施设计和整群随机对照试验 (RCT) 阶段和单向交叉阶段，密苏里州城乡地区 20 个 FQHC，包括约 100 个 PCP 大约 6,000 名符合福利资格的患者（即患有肥胖症的医疗补助接受者）将被分配到 CMOC 或 照常控制（IAUC）条件实施。洛阳钼业为医疗服务提供者提供肥胖护理能力培训 （例如，减轻体重偏差、结构能力）、特定学科的 USPSTF 护理和学习 合作期超过 12 个月，随后是 12 个月的可持续发展期。单向交叉阶段 在控制臂中实施 CMOC（在参与 IAUC 后）超过 12 个月。两个阶段都包括 培训后 12 个月和 24 个月进行评估。改善历史上边缘化群体的健康状况 我们提出的研究评估了 CMOC 的短期和长期临床和实施结果 与使用 RE-AIM 的 IAUC 相比。这项工作将有四个目标来指导。目标 1 比较患者层面的有效性 （即患者相对体重变化 (1a) 以及达到临床显着体重的患者比例 损失(1b))。目标 2 比较范围（患者治疗利用率）。目标 3 将 PCP 转诊与 12 岁时的护理进行比较 （领养；3a）和 24 个月（维持；3b），以及提供者肥胖护理的短期和长期变化 能力（3c）。目标 4 比较实施和服务成本。根据 NIDDK 战略重点， 我们的项目旨在推进社区循证护理的实施，最终扩大 为最需要帮助的人提供促进公平和享有没有残疾和疾病的未来的权利。