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Breland JY, Raikov I, Hoggatt KJ, Phibbs CS, Maguen S, Timko C, Saechao F, Frayne SM. Behavioral weight management use in the Veterans Health Administration: Sociodemographic and health correlates. Eat Behav 2024; 53:101864. [PMID: 38489933 DOI: 10.1016/j.eatbeh.2024.101864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 02/23/2024] [Accepted: 02/25/2024] [Indexed: 03/17/2024]
Abstract
INTRODUCTION Over 40 % of United States Veterans Health Administration (VHA) primary care patients have obesity. Few patients use VHA's flagship weight management program, MOVE! and there is little information on other behavioral weight management program use. METHODS The national United States cohort included over 1.5 million primary care patients with obesity, age 18-79, based on VHA administrative data. Gender stratified multivariable logistic regression identified correlates of weight management use in the year after a patient's first primary care appointment (alpha of 0.05). Weight management use was defined as MOVE! or nutrition clinic visits. RESULTS The cohort included 121,235 women and 1,521,547 men with 13 % and 7 % using weight management, respectively. Point estimates for specific correlates of use were similar between women and men, and across programs. Black patients were more likely to use weight management than White patients. Several physical and mental health diagnoses were also associated with increased use, such as sleep apnea and eating disorders. Age and distance from VHA were negatively associated with weight management use. CONCLUSIONS When assessing multiple types of weight management visits, weight management care in VHA appears to be used more often by some populations at higher risk for obesity. Other groups may need additional outreach, such as those living far from VHA. Future work should focus on outreach and prevention efforts to increase overall use rates. This work could also examine the benefits of tailoring care for populations in greatest need.
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Affiliation(s)
- Jessica Y Breland
- VA Palo Alto Health Care System, 795 Willow Road (MPD-152), Menlo Park, CA 94025, USA.
| | - Ivan Raikov
- VA Palo Alto Health Care System, 795 Willow Road (MPD-152), Menlo Park, CA 94025, USA
| | - Katherine J Hoggatt
- San Francisco VA Health Care System, 4150 Clement St, San Francisco, CA 94121, USA; University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143, USA
| | - Ciaran S Phibbs
- VA Palo Alto Health Care System, 795 Willow Road (MPD-152), Menlo Park, CA 94025, USA; Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, USA
| | - Shira Maguen
- San Francisco VA Health Care System, 4150 Clement St, San Francisco, CA 94121, USA; University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143, USA
| | - Christine Timko
- VA Palo Alto Health Care System, 795 Willow Road (MPD-152), Menlo Park, CA 94025, USA; Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, USA
| | - Fay Saechao
- VA Palo Alto Health Care System, 795 Willow Road (MPD-152), Menlo Park, CA 94025, USA
| | - Susan M Frayne
- VA Palo Alto Health Care System, 795 Willow Road (MPD-152), Menlo Park, CA 94025, USA; Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, USA
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Which patients benefit most from completing health risk assessments: comparing methods to identify heterogeneity of treatment effects. HEALTH SERVICES AND OUTCOMES RESEARCH METHODOLOGY 2021. [DOI: 10.1007/s10742-021-00243-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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McVay MA, Yancy WS, Bennett GG, Jung SH, Voils CI. Perceived barriers and facilitators of initiation of behavioral weight loss interventions among adults with obesity: a qualitative study. BMC Public Health 2018; 18:854. [PMID: 29996812 PMCID: PMC6042474 DOI: 10.1186/s12889-018-5795-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 07/04/2018] [Indexed: 01/25/2023] Open
Abstract
Background Evidence-based behavioral weight loss interventions are under-utilized. To inform efforts to increase uptake of these interventions, it is important to understand the perspectives of adults with obesity regarding barriers and facilitators of weight loss intervention initiation. Methods We conducted a qualitative study in adults with obesity who had recently attempted weight loss either with assistance from an evidence-based behavioral intervention (intervention initiators) or without use of a formal intervention (intervention non-initiators). We recruited primary care patients, members of a commercial weight loss program, and members of a Veterans Affairs weight loss program. Intervention initiators and non-initiators were interviewed separately using a semi-structured interview guide that asked participants about barriers and facilitators of weight loss intervention initiation. Conversations were audio-recorded and transcribed. Data were analyzed with qualitative content analysis. Two researchers used open coding to generate the code book on a subset of transcripts and a single researcher coded remaining transcripts. Codes were combined into subthemes, which were combined in to higher order themes. Intervention initiators and non-initiators were compared. Results We conducted three focus groups with participants who had initiated interventions (n = 26) and three focus groups (n = 24) and 8 individual interviews with participants who had not initiated interventions. Intervention initiators and non-initiators were, respectively, 65% and 37.5% white, 62% and 63% female, mean age of 55 and 54 years old, and mean BMI of 34 kg/m2. Three themes were identified. One theme was practical factors, with subthemes of reasonable cost and scheduling compatibility. A second theme was anticipated effectiveness of intervention, with subthemes of intervention content addressing individual needs; social aspects influencing effectiveness; and evaluating evidence of effectiveness. A third theme was anticipated pleasantness of intervention, with subthemes of social aspects influencing enjoyment; anticipated dietary and tracking prescriptions; and identity and self-reliance factors. Different perspectives were identified from intervention initiators and non-initiators. Conclusions Strategies to engage individuals in evidence-based weight loss interventions can be developed using these results. Strategies could target individuals’ perceived barriers and benefits to initiating interventions, or could focus on refining interventions to appeal to more individuals. Electronic supplementary material The online version of this article (10.1186/s12889-018-5795-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Megan A McVay
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, PO Box 118210, Gainesville, FL, 32611, USA.
| | - William S Yancy
- Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, 501 Douglas Street, Duke Diet & Fitness Center, Durham, NC, USA
| | - Gary G Bennett
- Department of Psychology and Neuroscience, Duke University, Box 90086, Durham, NC, 27708, USA.,Duke Global Health Institute, Duke University, 310 Trent St, Durham, NC, 27710, USA
| | - Seung-Hye Jung
- Duke Office of Clinical Research, Duke University Medical Center, 2424 Erwin Rd, Durham, NC, 27705, USA
| | - Corrine I Voils
- William Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI, 53705, USA.,Department of Surgery, Division of General Surgery, University of Wisconsin School of Medicine and Public Health, K6/100 Clinical Science CEnter, 600 Highland Ave, Madison, WI, 53792, USA
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Maciejewski ML, Shepherd-Banigan M, Raffa SD, Weidenbacher HJ. Systematic Review of Behavioral Weight Management Program MOVE! for Veterans. Am J Prev Med 2018; 54:704-714. [PMID: 29550164 DOI: 10.1016/j.amepre.2018.01.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 01/09/2018] [Accepted: 01/29/2018] [Indexed: 12/22/2022]
Abstract
CONTEXT Since 2006, the Veterans Health Administration has delivered a population-based behavioral weight management program (MOVE!) to Veterans, which numerous studies have examined. The purpose of this study was to systematically review these studies to understand MOVE! participation rates and the association between MOVE! participation and weight change. EVIDENCE ACQUISITION A December 2016 PubMed search identified 320 English-language abstracts published between January 1, 2005 and December 31, 2016, of which 42 underwent full-text review. Twenty-six articles were determined to be eligible for final inclusion and data elements extracted from these articles included study years, study design, content of MOVE! and control intervention (if any), inclusion/exclusion criteria, initial sample size and sample loss, intervention duration and follow-up, patient characteristics, and outcomes. Quality was assessed using the Newcastle-Ottawa Quality Scale. EVIDENCE SYNTHESIS Studies were judged to be of good quality. Twenty-one of the 26 studies were retrospective cohort studies, one was a prospective cohort study and four were randomized trials. Program participation varied substantially (2%-12%) across studies. Six-month weight loss ranged from -0.95 kg to -1.84 kg, whereas 12-month weight loss ranged from -0.13 kg to -3.3 kg. A maximum of 25% of MOVE! users engaged in intense and sustained participation (eight or more visits within 6 months), but higher participation levels were consistently associated with greater weight change (-1.18 kg to -5.3 kg at 6 months, -1.68 kg to -3.58 kg at 12 months). CONCLUSIONS MOVE! participation is associated with modest short-term weight loss, with greater weight loss as participation increases. More research is needed to understand the barriers and facilitators to participation and the effect of MOVE! participation on long-term health and economic outcomes.
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Affiliation(s)
- Matthew L Maciejewski
- Center for Health Services Research in Primary Care, Durham Department of Veterans Affairs Medical Center, Durham, North Carolina; Department of Population Health Sciences, Duke University Medical Center, Durham, North Carolina.
| | - Megan Shepherd-Banigan
- Center for Health Services Research in Primary Care, Durham Department of Veterans Affairs Medical Center, Durham, North Carolina
| | - Susan D Raffa
- Veterans Health Administration National Center for Health Promotion and Disease Prevention, Durham, North Carolina
| | - Hollis J Weidenbacher
- Center for Health Services Research in Primary Care, Durham Department of Veterans Affairs Medical Center, Durham, North Carolina
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Moin T, Damschroder LJ, Youles B, Makki F, Billington C, Yancy W, Maciejewski ML, Kinsinger LS, Weinreb JE, Steinle N, Richardson C. Implementation of a prediabetes identification algorithm for overweight and obese Veterans. ACTA ACUST UNITED AC 2018; 53:853-862. [PMID: 28273326 DOI: 10.1682/jrrd.2015.06.0104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 03/30/2016] [Indexed: 11/05/2022]
Abstract
Type 2 diabetes prevention is an important national goal for the Veteran Health Administration (VHA): one in four Veterans has diabetes. We implemented a prediabetes identification algorithm to estimate prediabetes prevalence among overweight and obese Veterans at Department of Veterans Affairs (VA) medical centers (VAMCs) in preparation for the launch of a pragmatic study of Diabetes Prevention Program (DPP) delivery to Veterans with prediabetes. This project was embedded within the VA DPP Clinical Demonstration Project conducted in 2012 to 2015. Veterans who attended orientation sessions for an established VHA weight-loss program (MOVE!) were recruited from VAMCs with geographically and racially diverse populations using existing referral processes. Each site implemented and adapted the prediabetes identification algorithm to best fit their local clinical context. Sites relied on an existing referral process in which a prediabetes identification algorithm was implemented in parallel with existing clinical flow; this approach limited the number of overweight and obese Veterans who were assessed and screened. We evaluated 1,830 patients through chart reviews, interviews, and/or laboratory tests. In this cohort, our estimated prevalence rates for normal glycemic status, prediabetes, and diabetes were 29% (n = 530), 28% (n = 504), and 43% (n = 796), respectively. Implementation of targeted prediabetes identification programs requires careful consideration of how prediabetes assessment and screening will occur.
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Affiliation(s)
- Tannaz Moin
- Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA; and David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.,Center for the Study of Healthcare Innovation, Implementation and Policy, Health Services Research & Development, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | | | - Bradley Youles
- VA Center for Clinical Management Research, Ann Arbor, MI
| | - Fatima Makki
- VA Center for Clinical Management Research, Ann Arbor, MI
| | - Charles Billington
- Minneapolis VA Health Care System, Minneapolis, MN; and University of Minnesota Medical Center, Minneapolis, MN
| | - William Yancy
- Durham VA Medical Center (VAMC), Durham, NC; and Duke University School of Medicine, Durham, NC
| | - Matthew L Maciejewski
- Durham VA Medical Center (VAMC), Durham, NC; and Duke University School of Medicine, Durham, NC
| | - Linda S Kinsinger
- National Center for Health Promotion and Disease Prevention, Veterans Health Administration, Durham, NC
| | - Jane E Weinreb
- Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA; and David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Nanette Steinle
- Baltimore VAMC, Baltimore, MD; and University of Maryland School of Medicine, Baltimore, MD
| | - Caroline Richardson
- VA Center for Clinical Management Research, Ann Arbor, MI.,Department of Family Medicine, University of Michigan, Ann Arbor, MI; and Diabetes Quality Enhancement Research Initiative (QUERI), VA, Ann Arbor, MI
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Patient factors associated with initiation of behavioral weight loss treatment: a prospective observational study in an integrated care setting. Transl Behav Med 2017; 7:75-83. [PMID: 27501799 DOI: 10.1007/s13142-016-0430-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Low enrollment in behavioral weight loss treatments limits their impact. We aimed to identify factors associated with treatment initiation. The participants were outpatients (n = 198) at Veterans Affairs (VA) healthcare facilities who were referred to a free VA-based behavioral weight loss treatment. Participants were assessed on psychosocial factors potentially relevant to treatment initiation. Subsequent treatment initiation was determined via medical record review. Study participants were 77 % male, 60 % African American, and 54 % initiated treatment. In multivariable analyses, treatment initiation was associated with being single, higher anxiety, and patients' perceptions that referring provider supported their weight autonomy. Endorsement of treatment barriers was not associated with treatment initiation. Treatments offering in-person sessions and mood management components were rated as more preferred. Initiation of behavioral weight loss treatments may increase if patients believe that providers respect their weight control autonomy and if healthcare organizations offer treatments that match patients' preferences.
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Moin T, Damschroder LJ, AuYoung M, Maciejewski ML, Datta SK, Weinreb JE, Steinle NI, Billington C, Hughes M, Makki F, Holleman RG, Kim HM, Jeffreys AS, Kinsinger LS, Burns JA, Richardson CR. Diabetes Prevention Program Translation in the Veterans Health Administration. Am J Prev Med 2017; 53:70-77. [PMID: 28094135 PMCID: PMC6699500 DOI: 10.1016/j.amepre.2016.11.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 10/19/2016] [Accepted: 11/08/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION This clinical demonstration trial compared the effectiveness of the Veterans Affairs Diabetes Prevention Program (VA-DPP) with an evidence-based usual care weight management program (MOVE!®) in the Veterans Health Administration health system. DESIGN Prospective, pragmatic, non-randomized comparative effectiveness study of two behavioral weight management interventions. SETTING/PARTICIPANTS Obese/overweight Veterans with prediabetes were recruited from three geographically diverse VA sites between 2012 and 2014. INTERVENTION VA-DPP included 22 group-based intensive lifestyle change sessions. MAIN OUTCOME MEASURES Weight change at 6 and 12 months, hemoglobin A1c (HbA1c) at 12 months, and VA health expenditure changes at 15 months were assessed using VA electronic health record and claims data. Between- and within-group comparisons for weight and HbA1c were done using linear mixed-effects models controlling for age, gender, race/ethnicity, baseline outcome values, and site. Analyses were conducted in 2015-2016. RESULTS A total of 387 participants enrolled (273 VA-DPP, 114 MOVE!). More VA-DPP participants completed at least one (73.3% VA-DPP vs 57.5% MOVE! p=0.002); four (57.5% VA-DPP vs 42.5% MOVE!, p=0.007); and eight or more sessions (42.5% VA-DPP vs 31% MOVE!, p=0.035). Weight loss from baseline was significant at both 6 (p<0.001) and 12 months (p<0.001) for VA-DPP participants, but only significant at 6 months for MOVE! participants (p=0.004). Between groups, there were significant differences in 6-month weight loss (-4.1 kg VA-DPP vs -1.9 kg MOVE!, p<0.001), but not 12-month weight loss (-3.4 kg VA-DPP vs -2.0 kg MOVE!, p=0.16). There were no significant differences in HbA1c change or outpatient, inpatient, and total VA expenditures. CONCLUSIONS VA-DPP participants had higher participation rates and weight loss at 6 months, but similar weight, HbA1c, and health expenditures at 12 months compared to MOVE! PARTICIPANTS Features of VA-DPP may help enhance the capability of MOVE! to reach a larger proportion of the served population and promote individual-level weight maintenance.
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Affiliation(s)
- Tannaz Moin
- Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California; VA Health Services Research and Development (HSR&D) Center for Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles, California.
| | | | - Mona AuYoung
- Ann Arbor VA Center for Clinical Management Research, Ann Arbor, Michigan
| | - Matthew L Maciejewski
- Department of Medicine, Durham VA Medical Center, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Santanu K Datta
- Department of Medicine, Durham VA Medical Center, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Jane E Weinreb
- Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Nanette I Steinle
- Department of Medicine, Baltimore VA Medical Center, Baltimore, Maryland; Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Charles Billington
- Department of Medicine, Minneapolis VA Healthcare System, Minneapolis, Minnesota; Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota
| | - Maria Hughes
- Ann Arbor VA Center for Clinical Management Research, Ann Arbor, Michigan
| | - Fatima Makki
- Ann Arbor VA Center for Clinical Management Research, Ann Arbor, Michigan
| | - Robert G Holleman
- Ann Arbor VA Center for Clinical Management Research, Ann Arbor, Michigan
| | - H Myra Kim
- Ann Arbor VA Center for Clinical Management Research, Ann Arbor, Michigan; Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, Michigan
| | - Amy S Jeffreys
- Department of Medicine, Durham VA Medical Center, Durham, North Carolina
| | - Linda S Kinsinger
- VHA National Center for Health Promotion and Disease Prevention, Durham, North Carolina
| | - Jennifer A Burns
- Ann Arbor VA Center for Clinical Management Research, Ann Arbor, Michigan
| | - Caroline R Richardson
- Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Family Medicine, University of Michigan, Ann Arbor, Michigan; VA Diabetes QUERI, Ann Arbor, Michigan
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Breland JY, Phibbs CS, Hoggatt KJ, Washington DL, Lee J, Haskell S, Uchendu US, Saechao FS, Zephyrin LC, Frayne SM. The Obesity Epidemic in the Veterans Health Administration: Prevalence Among Key Populations of Women and Men Veterans. J Gen Intern Med 2017; 32:11-17. [PMID: 28271422 PMCID: PMC5359156 DOI: 10.1007/s11606-016-3962-1] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Most US adults are overweight or obese. Understanding differences in obesity prevalence across subpopulations could facilitate the development and dissemination of weight management services. OBJECTIVES To inform Veterans Health Administration (VHA) weight management initiatives, we describe obesity prevalence among subpopulations of VHA patients. DESIGN Cross-sectional descriptive analyses of fiscal year 2014 (FY2014) national VHA administrative and clinical data, stratified by gender. Differences ≥5% higher than the population mean were considered clinically significant. PARTICIPANTS Veteran VHA primary care patients with a valid weight within ±365 days of their first FY2014 primary care visit, and a valid height (98% of primary care patients). MAIN MEASURES We used VHA vital signs data to ascertain height and weight and calculate body mass index, and VHA outpatient, inpatient, and fee basis data to identify sociodemographic- and comorbidity-based subpopulations. KEY RESULTS Among nearly five million primary care patients (347,112 women, 4,567,096 men), obesity prevalence was 41% (women 44%, men 41%), and overweight prevalence was 37% (women 31%, men 38%). Across the VHA's 140 facilities, obesity prevalence ranged from 28% to 49%. Among gender-stratified subpopulations, obesity prevalence was high among veterans under age 65 (age 18-44: women 40%, men 46%; age 45-64: women 49%, men 48%). Obesity prevalence varied across racial/ethnic and comorbidity subpopulations, with high obesity prevalence among black women (51%), women with schizophrenia (56%), and women and men with diabetes (68%, 56%). CONCLUSIONS Overweight and obesity are common among veterans served by the VHA. VHA's weight management initiatives have the potential to avert long-term morbidity arising from obesity-related conditions. High-risk groups-such as black women veterans, women veterans with schizophrenia, younger veterans, and Native Hawaiian/Other Pacific Islander and American Indian/Alaska Native veterans-may require particular attention to ensure that systems improvement efforts at the population level do not inadvertently increase health disparities.
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Affiliation(s)
- Jessica Y Breland
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road (MPD-152), Menlo Park, CA, 94025, USA.
- Stanford University School of Medicine, Stanford, CA, USA.
| | - Ciaran S Phibbs
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road (MPD-152), Menlo Park, CA, 94025, USA
- Stanford University School of Medicine, Stanford, CA, USA
| | - Katherine J Hoggatt
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Donna L Washington
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jimmy Lee
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road (MPD-152), Menlo Park, CA, 94025, USA
| | - Sally Haskell
- United States Department of Veterans Affairs Central Office, Women's Health Services, Washington, DC, USA
- West Haven VA, West Haven, CT, USA
- Yale University School of Medicine, New Haven, CT, USA
| | - Uchenna S Uchendu
- United States Department of Veterans Affairs Central Office, Office of Health Equity, Washington, DC, USA
| | - Fay S Saechao
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road (MPD-152), Menlo Park, CA, 94025, USA
| | - Laurie C Zephyrin
- United States Department of Veterans Affairs Central Office, Women's Health Services, Washington, DC, USA
- New York University School of Medicine, New York, NY, USA
| | - Susan M Frayne
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road (MPD-152), Menlo Park, CA, 94025, USA
- Stanford University School of Medicine, Stanford, CA, USA
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Chen S, Banks WA, Silverman J, Sheffrin M, Thielke SM. Methods Employed to Assess Weight Loss in Older Adults by Means of Electronic Medical Records: A Systematic Review. J Nutr Gerontol Geriatr 2017; 36:18-30. [PMID: 28207372 DOI: 10.1080/21551197.2017.1282390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Electronic medical records (EMRs) can be used to identify and categorize weight loss in older adults, but research has not scrutinized methods for doing so. Through a modified PRISMA protocol, we systematically reviewed published methods for quantifying weight change from EMRs. Articles (all available through July 2016) were identified through PubMed and SCOPUS searches, screened, and evaluated. We abstracted relevant data and tabulated the methods to assess weight change. The 13 selected articles showed little consistency in the approach to key methodological issues: 1) time ranges assessed; 2) removal of spurious values; 3) metrics to quantify weight change; 4) number of measures needed to estimate change; 5) threshold for significant weight change; and 6) relation to ideal weight. There was essentially no consensus around how to identify and categorize weight loss. Further investigation is needed to establish scientifically validated and clinically useful algorithms, accounting for the six issues above.
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Affiliation(s)
- Sunny Chen
- a Geriatric Research Education and Clinical Center , Veterans Affairs Puget Sound Health Care Center , Seattle , Washington , USA
| | - William A Banks
- a Geriatric Research Education and Clinical Center , Veterans Affairs Puget Sound Health Care Center , Seattle , Washington , USA.,b Division of Gerontology and Geriatric Medicine, Department of Medicine , University of Washington School of Medicine , Seattle , Washington , USA
| | - Julie Silverman
- d Health Services Research and Development , Puget Sound VA Medical Center , Seattle , Washington , USA.,e Department of Medicine , University of Washington School of Medicine , Seattle , Washington , USA
| | - Meera Sheffrin
- f Geriatric Medicine, Division of General Medical Disciplines , Stanford University School of Medicine , Stanford , California , USA
| | - Stephen M Thielke
- a Geriatric Research Education and Clinical Center , Veterans Affairs Puget Sound Health Care Center , Seattle , Washington , USA.,c Department of Psychiatry and Behavioral Sciences , University of Washington School of Medicine , Seattle , Washington , USA
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Park SJ, Yang HM, Seo KW, Choi SY, Choi BJ, Yoon MH, Hwang GS, Tahk SJ, Sheen SS, Choi BIW, Lim HS. The relationship between coronary atherosclerosis and body fat distribution measured using dual energy X-ray absorptiometry. Atherosclerosis 2016; 248:190-5. [PMID: 27018543 DOI: 10.1016/j.atherosclerosis.2016.03.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 02/24/2016] [Accepted: 03/10/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Body fat distribution is closely related to cardiovascular diseases. We aimed to evaluate the relationship between truncal fat distribution and the extent of coronary atherosclerosis. METHODS Total body fat and regional body fat distributions were measured using dual-energy X-ray absorptiometry (DXA) in 746 Korean patients who underwent coronary angiography. The ratios of truncal fat mass to total body fat mass (FMtrunk/FMtotal), truncal fat mass to fat mass in both legs (FMtrunk/FMleg) and truncal fat mass to fat mass in both arms (FMtrunk/FMarm) were calculated as representative parameters for truncal fat accumulation. The extent of coronary atherosclerosis was assessed using the Gensini score. RESULTS The mean Gensini score of the patients was 21.3 ± 24.4. FMtrunk/FMtotal, FMtrunk/FMleg and FMtrunk/FMarm revealed positive correlations with the Gensini score (r = 0.242, p < 0.001; r = 0.219, p < 0.001; r = 0.133, p < 0.001, respectively). In contrast, body mass index (BMI) and total body fat mass did not correlate with the Gensini score. On multiple regression analysis, FMtrunk/FMtotal was associated with the Gensini score independently of age, gender, BMI and major risk factors of coronary heart disease (B = 0.039, p < 0.001). CONCLUSION Truncal fat distribution is associated with the extent of coronary atherosclerosis and more clinically relevant to that compared with total body fat or BMI in Korean patients.
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Affiliation(s)
- Se-Jun Park
- Department of Cardiology, Ajou University School of Medicine, 164 Worldcup-Ro, Suwon 16499, Republic of Korea; Division of Cardiology, Cardiovascular Center, Chun-Cheon Sacred Heart Hospital, Hallym University College of Medicine, 77 Sakju-Ro, Chun-Cheon 24253, Republic of Korea
| | - Hyoung-Mo Yang
- Department of Cardiology, Ajou University School of Medicine, 164 Worldcup-Ro, Suwon 16499, Republic of Korea
| | - Kyoung-Woo Seo
- Department of Cardiology, Ajou University School of Medicine, 164 Worldcup-Ro, Suwon 16499, Republic of Korea
| | - So-Yeon Choi
- Department of Cardiology, Ajou University School of Medicine, 164 Worldcup-Ro, Suwon 16499, Republic of Korea
| | - Byoung-Joo Choi
- Department of Cardiology, Ajou University School of Medicine, 164 Worldcup-Ro, Suwon 16499, Republic of Korea
| | - Myeong-Ho Yoon
- Department of Cardiology, Ajou University School of Medicine, 164 Worldcup-Ro, Suwon 16499, Republic of Korea
| | - Gyo-Seung Hwang
- Department of Cardiology, Ajou University School of Medicine, 164 Worldcup-Ro, Suwon 16499, Republic of Korea
| | - Seung-Jea Tahk
- Department of Cardiology, Ajou University School of Medicine, 164 Worldcup-Ro, Suwon 16499, Republic of Korea
| | - Seung-Soo Sheen
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, 164 Worldcup-Ro, Suwon 16499, Republic of Korea
| | - Byung-Il W Choi
- Department of Cardiology, Medical College of Wisconsin, Milwaukee, WI 53266, USA
| | - Hong-Seok Lim
- Department of Cardiology, Ajou University School of Medicine, 164 Worldcup-Ro, Suwon 16499, Republic of Korea.
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Damschroder LJ, Moin T, Datta SK, Reardon CM, Steinle N, Weinreb J, Billington CJ, Maciejewski ML, Yancy WS, Hughes M, Makki F, Richardson CR. Implementation and evaluation of the VA DPP clinical demonstration: protocol for a multi-site non-randomized hybrid effectiveness-implementation type III trial. Implement Sci 2015; 10:68. [PMID: 25962598 PMCID: PMC4429938 DOI: 10.1186/s13012-015-0250-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 04/18/2015] [Indexed: 01/07/2023] Open
Abstract
Background The Diabetes Prevention Program (DPP) study showed that lifestyle intervention resulted in a 58% reduction in incidence of type 2 diabetes among individuals with prediabetes. Additional large randomized controlled trials have confirmed these results, and long-term follow-up has shown sustained benefit 10–20 years after the interventions ended. Diabetes is a common and costly disease, especially among Veterans, and despite strong evidence supporting the feasibility of type 2 diabetes prevention, the DPP has not been widely implemented. The first aim of this study will evaluate implementation of the Veterans Affairs (VA) DPP in three VA medical centers. The second aim will assess weight and hemoglobin A1c (A1c) outcomes, and the third aim will determine the cost-effectiveness and budget impact of implementation of the VA DPP from a health system perspective. Methods/Design This partnered multi-site non-randomized systematic assignment study will use a highly pragmatic hybrid effectiveness-implementation type III mixed methods study design. The implementation and administration of the VA DPP will be funded by clinical operations while the evaluation of the VA DPP will be funded by research grants. Seven hundred twenty eligible Veterans will be systematically assigned to the VA DPP clinical demonstration or the usual care VA MOVE!® weight management program. A multi-phase formative evaluation of the VA DPP implementation will be conducted. A theoretical program change model will be used to guide the implementation process and assess applicability and feasibility of the DPP for VA. The Consolidated Framework for Implementation Research (CFIR) will be used to guide qualitative data collection, analysis, and interpretation of barriers and facilitators to implementation. The RE-AIM framework will be used to assess Reach, Effectiveness, Adoption, Implementation, and Maintenance of the VA DPP. Twelve-month weight and A1c change will be evaluated for the VA DPP compared to the VA MOVE! program. Mediation analyses will be conducted to identify whether program design differences impact outcomes. Discussion Findings from this pragmatic evaluation will be highly applicable to practitioners who are tasked with implementing the DPP in clinical settings. In addition, findings will determine the effectiveness and cost-effectiveness of the VA DPP in the Veteran population. Electronic supplementary material The online version of this article (doi:10.1186/s13012-015-0250-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Laura J Damschroder
- Ann Arbor VA Center for Clinical Management Research, P.O. Box 130170, Ann Arbor, MI, 48113-0170, USA. .,VA Diabetes QUERI, Ann Arbor, MI, USA.
| | - Tannaz Moin
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. .,David Geffen School of Medicine, University of California, Los Angeles, CA, USA. .,Greater Los Angeles VA Health Services Research and Development (HSR & D) Center for Healthcare Innovation, Implementation and Policy, Los Angeles, CA, USA.
| | - Santanu K Datta
- Durham VA Medical Center, Durham, NC, USA. .,Duke University School of Medicine, Durham, NC, USA.
| | - Caitlin M Reardon
- Ann Arbor VA Center for Clinical Management Research, P.O. Box 130170, Ann Arbor, MI, 48113-0170, USA.
| | - Nanette Steinle
- Baltimore VA Medical Center, Baltimore, MD, USA. .,University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Jane Weinreb
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. .,David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
| | - Charles J Billington
- Minneapolis VA Healthcare System, Minneapolis, MN, USA. .,University of Minnesota Medical Center, Minneapolis, MN, USA.
| | - Matt L Maciejewski
- Durham VA Medical Center, Durham, NC, USA. .,Duke University School of Medicine, Durham, NC, USA.
| | - William S Yancy
- Durham VA Medical Center, Durham, NC, USA. .,Duke University School of Medicine, Durham, NC, USA.
| | - Maria Hughes
- Ann Arbor VA Center for Clinical Management Research, P.O. Box 130170, Ann Arbor, MI, 48113-0170, USA.
| | - Fatima Makki
- Ann Arbor VA Center for Clinical Management Research, P.O. Box 130170, Ann Arbor, MI, 48113-0170, USA.
| | - Caroline R Richardson
- Ann Arbor VA Center for Clinical Management Research, P.O. Box 130170, Ann Arbor, MI, 48113-0170, USA. .,VA Diabetes QUERI, Ann Arbor, MI, USA. .,Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA.
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