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Feigelson HS, Clarke CL, Van Den Eeden SK, Weinmann S, Burnett-Hartman AN, Rowell S, Scott SG, White LL, Ter-Minassian M, Honda SAA, Young DR, Kamineni A, Chinn T, Lituev A, Bauck A, McGlynn EA. The Kaiser Permanente Research Bank Cancer Cohort: a collaborative resource to improve cancer care and survivorship. BMC Cancer 2022; 22:209. [PMID: 35216576 PMCID: PMC8876075 DOI: 10.1186/s12885-022-09252-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/21/2022] [Indexed: 12/04/2022] Open
Abstract
Background The Kaiser Permanente Research Bank (KPRB) is collecting biospecimens and surveys linked to electronic health records (EHR) from approximately 400,000 adult KP members. Within the KPRB, we developed a Cancer Cohort to address issues related to cancer survival, and to understand how genetic, lifestyle and environmental factors impact cancer treatment, treatment sequelae, and prognosis. We describe the Cancer Cohort design and implementation, describe cohort characteristics after 5 years of enrollment, and discuss future directions. Methods Cancer cases are identified using rapid case ascertainment algorithms, linkage to regional or central tumor registries, and direct outreach to KP members with a history of cancer. Enrollment is primarily through email invitation. Participants complete a consent form, survey, and donate a blood or saliva sample. All cancer types are included. Results As of December 31, 2020, the cohort included 65,225 cases (56% female, 44% male) verified in tumor registries. The largest group was diagnosed between 60 and 69 years of age (31%) and are non-Hispanic White (83%); however, 10,076 (16%) were diagnosed at ages 18–49 years, 4208 (7%) are Hispanic, 3393 (5%) are Asian, and 2389 (4%) are Black. The median survival time is 14 years. Biospecimens are available on 98% of the cohort. Conclusions The KPRB Cancer Cohort is designed to improve our understanding of treatment efficacy and factors that contribute to long-term cancer survival. The cohort’s diversity - with respect to age, race/ethnicity and geographic location - will facilitate research on factors that contribute to cancer survival disparities.
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Affiliation(s)
- Heather Spencer Feigelson
- Institute for Health Research, Kaiser Permanente, 2550 S. Parker Rd, Suite 200, Aurora, CO, 80014, USA.
| | - Christina L Clarke
- Institute for Health Research, Kaiser Permanente, 2550 S. Parker Rd, Suite 200, Aurora, CO, 80014, USA
| | | | - Sheila Weinmann
- Center for Health Research, Kaiser Permanente, 3800 N. Interstate Ave, Portland, OR, 97227, USA
| | - Andrea N Burnett-Hartman
- Institute for Health Research, Kaiser Permanente, 2550 S. Parker Rd, Suite 200, Aurora, CO, 80014, USA
| | - Sarah Rowell
- Kaiser Permanente Program Office, 1800 Harrison, 16th floor, Oakland, CA, 94612, USA
| | - Shauna Goldberg Scott
- Institute for Health Research, Kaiser Permanente, 2550 S. Parker Rd, Suite 200, Aurora, CO, 80014, USA
| | - Larissa L White
- Institute for Health Research, Kaiser Permanente, 2550 S. Parker Rd, Suite 200, Aurora, CO, 80014, USA
| | - Monica Ter-Minassian
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente, 2101 East Jefferson St, 3 West, Rockville, MD, 20852, USA
| | - Stacey A A Honda
- Center for Integrated Healthcare Research and Hawai'i Permanente Medical Group, Kaiser Permanente, 501 Alakawa St Suite 201, Honolulu, HI, 96817, USA
| | - Deborah R Young
- Department of Research and Evaluation, Kaiser Permanente, 100 S. Los Robles Avenue, Pasadena, CA, 91101, USA
| | - Aruna Kamineni
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave Suite 1600, Seattle, WA, 98101, USA
| | - Terrence Chinn
- Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA, 94612, USA
| | - Alexander Lituev
- Kaiser Permanente Research Bank, Kaiser Permanente, 1795 A Second St, Berkeley, CA, 94710, USA
| | - Alan Bauck
- Center for Health Research, Kaiser Permanente, 3800 N. Interstate Ave, Portland, OR, 97227, USA
| | - Elizabeth A McGlynn
- Kaiser Permanente Research & Quality Measurement and Kaiser Permanente Research Bank, 100 S. Los Robles, 3rd floor, Pasadena, CA, 91101, USA
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Feigelson HS, Clarke C, Hartman AB, Van Den Eeden S, Weinmann S, Ter-Minassian M, Honda S, Young D, Kamineni A, Rowell S, Bauck A, McGlynn E. Abstract PO-178: The Kaiser Permanente Research Bank cancer cohort: A diverse resource to improve cancer care. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp20-po-178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Kaiser Permanente (KP) is an ideal environment to study the spectrum of cancer prevention and control because it provides comprehensive cancer care to a large and diverse community. The Kaiser Permanente Research Bank (KPRB) is collecting biospecimens and a survey of health-related behaviors and other risk factors from about 400,000 adults aged 18 years and older across all eight KP regions. The KPRB includes a cancer cohort and cases are identified from KP region-specific algorithms designed to identify cancer cases within days of diagnosis, and from linkage with regional tumor registries. KPRB participation involves completing an online informed consent and survey, and providing a blood or saliva sample. KPRB participants consent to linkage to their electronic health record (EHR), which includes comprehensive information about cancer screening, diagnosis and treatment. A key strength of this cohort is its diversity with respect to age, race/ethnicity, and geographic location (Hawai’i, Oregon, Washington state, California, Colorado, Georgia, and the Washington, DC area). To date, the KPRB includes 68,000 cancer cases, 56% are women, and 30% are non-white. Over 8,500 cases were diagnosed before the age of 50 and the cohort includes substantial numbers of cancer cases among Asian and Pacific Islanders (n=8,941), Hispanics (n=7,678), and non-Hispanic blacks (n=5,367). Although all cohort members have insurance, and thus, presumably access to care, we observed disparities in stage at diagnosis. Compared to non- Hispanic whites, non-Hispanic Blacks are more likely to be diagnosed at stage 4 (5% versus 16%, respectively, of all cases); participants describing themselves as multi- racial or “other” race similarly have a very high proportion (25%) of cases diagnosed at stage 4. Research is planned to examine the factors associated with this disparity. The extensive EHR, access to stored tissue specimens, detailed treatment data, and ability to follow patients over time for recurrence and mortality make the KPRB Cancer Cohort an exceptional resource for exploring the factors that contribute to cancer etiology, progression, and survival. We invite investigators to apply to use the KPRB (https://researchbank.kaiserpermanente.org/) to accelerate progress toward improving cancer care.
Citation Format: Heather S. Feigelson, Christina Clarke, Andrea Burnett- Hartman, Stephen Van Den Eeden, Sheila Weinmann, Monica Ter-Minassian, Stacey Honda, Deborah Young, Aruna Kamineni, Sarah Rowell, Alan Bauck, Elizabeth McGlynn. The Kaiser Permanente Research Bank cancer cohort: A diverse resource to improve cancer care [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-178.
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Richesson RL, Green BB, Laws R, Puro J, Kahn MG, Bauck A, Smerek M, Van Eaton EG, Zozus M, Hammond WE, Stephens KA, Simon GE. Pragmatic (trial) informatics: a perspective from the NIH Health Care Systems Research Collaboratory. J Am Med Inform Assoc 2018; 24:996-1001. [PMID: 28340241 DOI: 10.1093/jamia/ocx016] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 02/14/2017] [Indexed: 11/14/2022] Open
Abstract
Pragmatic clinical trials (PCTs) are research investigations embedded in health care settings designed to increase the efficiency of research and its relevance to clinical practice. The Health Care Systems Research Collaboratory, initiated by the National Institutes of Health Common Fund in 2010, is a pioneering cooperative aimed at identifying and overcoming operational challenges to pragmatic research. Drawing from our experience, we present 4 broad categories of informatics-related challenges: (1) using clinical data for research, (2) integrating data from heterogeneous systems, (3) using electronic health records to support intervention delivery or health system change, and (4) assessing and improving data capture to define study populations and outcomes. These challenges impact the validity, reliability, and integrity of PCTs. Achieving the full potential of PCTs and a learning health system will require meaningful partnerships between health system leadership and operations, and federally driven standards and policies to ensure that future electronic health record systems have the flexibility to support research.
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Affiliation(s)
- Rachel L Richesson
- Division of Clinical Systems and Analytics, Duke University School of Nursing, Durham, NC, USA.,Duke Center for Health Informatics, Durham, NC, USA
| | - Beverly B Green
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Reesa Laws
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | | | - Michael G Kahn
- Department of Pediatrics, University of Colorado, Denver, CO, USA
| | - Alan Bauck
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Michelle Smerek
- Clinical Research Informatics, Duke Clinical Research Institute, Durham, NC, USA
| | - Erik G Van Eaton
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Meredith Zozus
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - W Ed Hammond
- Duke Center for Health Informatics, Durham, NC, USA
| | - Kari A Stephens
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Greg E Simon
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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Coughlin JW, Brantley PJ, Champagne CM, Vollmer WM, Stevens VJ, Funk K, Dalcin AT, Jerome GJ, Myers VH, Tyson C, Batch BC, Charleston J, Loria CM, Bauck A, Hollis JF, Svetkey LP, Appel LJ. The impact of continued intervention on weight: Five-year results from the weight loss maintenance trial. Obesity (Silver Spring) 2016; 24:1046-53. [PMID: 26991814 PMCID: PMC4896740 DOI: 10.1002/oby.21454] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 12/16/2015] [Indexed: 01/29/2023]
Abstract
OBJECTIVE In the Weight Loss Maintenance (WLM) Trial, a personal contact (PC) intervention sustained greater weight loss relative to a self-directed (SD) group over 30 months. This study investigated the effects of continued intervention over an additional 30 months and overall weight change across the entire WLM Trial. METHODS WLM had 3 phases. Phase 1 was a 6-month weight loss program. In Phase 2, those who lost ≥4 kg were randomized to a 30-month maintenance trial. In Phase 3, PC participants (n = 196, three sites) were re-randomized to no further intervention (PC-Control) or continued intervention (PC-Active) for 30 more months; 218 SD participants were also followed. RESULTS During Phase 3, weight increased 1.0 kg in PC-Active and 0.5 kg in PC-Control (mean difference 0.6 kg; 95% CI:-1.4 to 2.7; P = 0.54). Mean weight change over the entire study was -3.2 kg in those originally assigned to PC (PC-Combined) and -1.6 kg in SD (mean difference -1.6 kg; 95% CI:-3.0 to -0.1; P = 0.04). CONCLUSIONS After 30 months of the PC maintenance intervention, continuation for another 30 months provided no additional benefit. However, across the entire study, weight loss was slightly greater in those originally assigned to PC.
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Affiliation(s)
- Janelle W. Coughlin
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - Phillip J. Brantley
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Catherine M. Champagne
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
| | - William M. Vollmer
- The Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Victor J. Stevens
- The Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Kristine Funk
- The Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Arlene T. Dalcin
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - Gerald J. Jerome
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Kinesiology, Towson University, Towson, Maryland, USA
| | | | - Crystal Tyson
- Division of Nephrology/Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
- Duke Hypertension Center and Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Bryan C. Batch
- Duke Hypertension Center and Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Jeanne Charleston
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Alan Bauck
- The Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Jack F. Hollis
- The Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Laura P. Svetkey
- Division of Nephrology/Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
- Duke Hypertension Center and Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Lawrence J. Appel
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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Fung KW, Richesson R, Smerek M, Pereira KC, Green BB, Patkar A, Clowse M, Bauck A, Bodenreider O. Preparing for the ICD-10-CM Transition: Automated Methods for Translating ICD Codes in Clinical Phenotype Definitions. EGEMS (Wash DC) 2016; 4:1211. [PMID: 27195309 PMCID: PMC4862764 DOI: 10.13063/2327-9214.1211] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background: The national mandate for health systems to transition from ICD-9-CM to ICD-10-CM in October 2015 has an impact on research activities. Clinical phenotypes defined by ICD-9-CM codes need to be converted to ICD-10-CM, which has nearly four times more codes and a very different structure than ICD-9-CM. Methods: We used the Centers for Medicare & Medicaid Services (CMS) General Equivalent Maps (GEMs) to translate, using four different methods, condition-specific ICD-9-CM code sets used for pragmatic trials (n=32) into ICD-10-CM. We calculated the recall, precision, and F score of each method. We also used the ICD-9-CM and ICD-10-CM value sets defined for electronic quality measure as an additional evaluation of the mapping methods. Results: The forward-backward mapping (FBM) method had higher precision, recall and F-score metrics than simple forward mapping (SFM). The more aggressive secondary (SM) and tertiary mapping (TM) methods resulted in higher recall but lower precision. For clinical phenotype definition, FBM was the best (F=0.67), but was close to SM (F=0.62) and TM (F=0.60), judging on the F-scores alone. The overall difference between the four methods was statistically significant (one-way ANOVA, F=5.749, p=0.001). However, pairwise comparisons between FBM, SM, and TM did not reach statistical significance. A similar trend was found for the quality measure value sets. Discussion: The optimal method for using the GEMs depends on the relative importance of recall versus precision for a given use case. It appears that for clinically distinct and homogenous conditions, the recall of FBM is sufficient. The performance of all mapping methods was lower for heterogeneous conditions. Since code sets used for phenotype definition and quality measurement can be very similar, there is a possibility of cross-fertilization between the two activities. Conclusion: Different mapping approaches yield different collections of ICD-10-CM codes. All methods require some level of human validation.
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Affiliation(s)
| | | | | | | | | | - Ashwin Patkar
- Duke Clinical Research Institute; Duke University School of Medicine
| | | | - Alan Bauck
- Center for Health Research, Kaiser Permanente Northwest
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McGlynn EA, Lieu TA, Durham ML, Bauck A, Laws R, Go AS, Chen J, Feigelson HS, Corley DA, Young DR, Nelson AF, Davidson AJ, Morales LS, Kahn MG. Developing a data infrastructure for a learning health system: the PORTAL network. J Am Med Inform Assoc 2014; 21:596-601. [PMID: 24821738 PMCID: PMC4078291 DOI: 10.1136/amiajnl-2014-002746] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 03/10/2014] [Indexed: 11/06/2022] Open
Abstract
The Kaiser Permanente & Strategic Partners Patient Outcomes Research To Advance Learning (PORTAL) network engages four healthcare delivery systems (Kaiser Permanente, Group Health Cooperative, HealthPartners, and Denver Health) and their affiliated research centers to create a new national network infrastructure that builds on existing relationships among these institutions. PORTAL is enhancing its current capabilities by expanding the scope of the common data model, paying particular attention to incorporating patient-reported data more systematically, implementing new multi-site data governance procedures, and integrating the PCORnet PopMedNet platform across our research centers. PORTAL is partnering with clinical research and patient experts to create cohorts of patients with a common diagnosis (colorectal cancer), a rare diagnosis (adolescents and adults with severe congenital heart disease), and adults who are overweight or obese, including those with pre-diabetes or diabetes, to conduct large-scale observational comparative effectiveness research and pragmatic clinical trials across diverse clinical care settings.
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Affiliation(s)
- Elizabeth A McGlynn
- Kaiser Permanente Center for Effectiveness and Safety Research, Pasadena, California, USA
| | - Tracy A Lieu
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Mary L Durham
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Alan Bauck
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Reesa Laws
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Jersey Chen
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland, USA
| | | | - Douglas A Corley
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Deborah Rohm Young
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Andrew F Nelson
- HealthPartners Institute for Education and Research, Minneapolis, Minnesota, USA
| | | | - Leo S Morales
- Group Health Cooperative, Group Health Research Institute, Seattle, Washington, USA
| | - Michael G Kahn
- Department of Pediatrics, University of Colorado, Aurora, Colorado, USA
- Colorado Clinical and Translational Sciences Institute, Aurora, Colorado, USA
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Perrin NA, Stiefel M, Mosen DM, Bauck A, Shuster E, Dirks EM. Self-reported health and functional status information improves prediction of inpatient admissions and costs. Am J Manag Care 2011; 17:e472-e478. [PMID: 22216871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To determine whether adding selfreported health and functional status data to a diagnostic risk-score model explains additional variance in predicting inpatient admissions and costs. STUDY DESIGN Retrospective observational analysis. METHODS We used data from a Health Status Questionnaire (HSQ), completed by 6407 Kaiser Permanente Northwest Medicare patients between December 2006 and October 2008. We used answers from 3 items on the HSQ: (1) General Self-rated Health score, (2) needing help with 1 or more activities of daily living, and (3) having a bothersome health condition. We calculated a DxCG relative risk score from utilization information in the year prior to the survey, using electronic medical records. We compared: (1) DxCG as the sole independent variable and (2) DxCG plus the 3 items as independent variables. We estimated area under the curve (AUC) for each model. Any inpatient admission (yes/no) and being in the top 10% of costs (in the year after survey) were the dependent variables for the first and second logistic regression models, respectively. RESULTS The 3 items explained an additional 2.8% and 4.0% of variance for inpatient admissions and top 10% of costs,respectively, in addition to the variance explained by the DxCG score alone. For DxCG alone, the AUC was 0.686 (95% confidence interval [CI] 0.663-0.710) and 0.741 (95% CI 0.719- 0.764), respectively, for inpatient admissions and top 10% of costs and improved to 0.709 (95% CI 0.687-0.730) and 0.770 (95% CI 0.749-0.790) when the 3 self-reported items were added. CONCLUSIONS Using self-reported health information improved the predictive power of a DxCG model to forecast inpatient admissions and patient cost-tier.
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Affiliation(s)
- Nancy A Perrin
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA.
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Funk KL, Stevens VJ, Bauck A, Brantley PJ, Hornbrook M, Jerome GJ, Myers VH, Appel L. Development and Implementation of a Tailored Self-assessment Tool in an Internet-based Weight Loss Maintenance Program. Clin Pract Epidemiol Ment Health 2011; 7:67-73. [PMID: 21566735 PMCID: PMC3092445 DOI: 10.2174/1745017901107010067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Revised: 07/13/2010] [Accepted: 08/24/2010] [Indexed: 11/22/2022]
Abstract
BACKGROUND Using the Internet to replicate client/counselor interactions provides a tremendous opportunity to disseminate interventions at relatively low cost per participant. However, there are substantial challenges with this approach. The Weight Loss Maintenance Trial (WLM) compared two long-term weight-maintenance interventions: (1) a personal contact arm and (2) an Internet arm, to a third self-directed control arm. The Internet arm focused on use of an interactive website for support of long-term weight maintenance. This paper describes a highly interactive self-assessment tool developed for use in the WLM trial Internet intervention arm. METHODS The Tailored Self-Assessment (TSA) website tool was an interactive resource for those WLM participants assigned to the Internet arm to review their personal weight-management progress and make choices about future weight-management actions. The TSA was highly tailored and ended with a suggested list of personalized action plans. While the participant could complete the TSA at any time, criteria-based reminder messages prompted participation. RESULTS The TSA was one of 27 interactive tools on the WLM website. Over the course of the 28 months, the TSA was completed 800 times by the 348 randomized participants. Fifty-three percent of the participants (185/348) used the TSA at least once (range: 0, 110) and 72% of the 185 participants who did complete the TSA at least once, completed it more than once. CONCLUSION The Internet has great potential to impact health behavior by attempting to replicate personal counseling. We learned that while development is complex and appears costly, tailored strategies based on client feedback are likely worthwhile and should be formally tested.
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Affiliation(s)
- Kristine L Funk
- Kaiser Permanente, Center for Health Research, Portland, OR, USA
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Funk KL, Stevens VJ, Appel LJ, Bauck A, Brantley PJ, Champagne CM, Coughlin J, Dalcin AT, Harvey-Berino J, Hollis JF, Jerome GJ, Kennedy BM, Lien LF, Myers VH, Samuel-Hodge C, Svetkey LP, Vollmer WM. Associations of internet website use with weight change in a long-term weight loss maintenance program. J Med Internet Res 2010; 12:e29. [PMID: 20663751 PMCID: PMC2956327 DOI: 10.2196/jmir.1504] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Revised: 03/19/2010] [Accepted: 03/20/2010] [Indexed: 11/23/2022] Open
Abstract
Background The Weight Loss Maintenance Trial (WLM) compared two long-term weight-maintenance interventions, a personal contact arm and an Internet arm, with a no-treatment control after an initial six-month Phase I weight loss program. The Internet arm focused on use of an interactive website for support of long-term weight maintenance. There is limited information about patterns of website use and specific components of an interactive website that might help promote maintenance of weight loss. Objective This paper presents a secondary analysis of the subset of participants in the Internet arm and focuses on website use patterns and features associated with long-term weight maintenance. Methods Adults at risk for cardiovascular disease (CVD) who lost at least 4 kilograms in an initial 20-week group-based, behavioral weight-loss program were trained to use an interactive website for weight loss maintenance. Of the 348 participants, 37% were male and 38% were African American. Mean weight loss was 8.6 kilograms. Participants were encouraged to log in at least weekly and enter a current weight for the 30-month study period. The website contained features that encouraged setting short-term goals, creating action plans, and reinforcing self-management habits. The website also included motivational modules, daily tips, and tailored messages. Based on log-in and weight-entry frequency, we divided participants into three website use categories: consistent, some, and minimal. Results Participants in the consistent user group (n = 212) were more likely to be older (P = .002), other than African American (P = .02), and more educated (P = .01). While there was no significant difference between website use categories in the amount of Phase I change in body weight (P = .45) or income (P = .78), minimal website users (n = 75) were significantly more likely to have attended fewer Phase I sessions (P = .001) and had a higher initial body mass index (BMI) (P < .001). After adjusting for baseline characteristics including initial BMI, variables most associated with less weight regain included: number of log-ins (P = .001), minutes on the website (P < .001), number of weight entries (P = .002), number of exercise entries (P < .001), and sessions with additional use of website features after weight entry (P = .002). Conclusion Participants defined as consistent website users of an interactive behavioral website designed to promote maintenance of weight loss were more successful at maintaining long-term weight loss. Trial Registration NCT00054925; http://clinicaltrials.gov/ct2/show/NCT00054925 (Archived by WebCite at http://www.webcitation.org/5rC7523ue)
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Affiliation(s)
- Kristine L Funk
- Kaiser Permanente, Center for Health Research, Portland, USA.
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Svetkey LP, Stevens VJ, Brantley PJ, Appel LJ, Hollis JF, Loria CM, Vollmer WM, Gullion CM, Funk K, Smith P, Samuel-Hodge C, Myers V, Lien LF, Laferriere D, Kennedy B, Jerome GJ, Heinith F, Harsha DW, Evans P, Erlinger TP, Dalcin AT, Coughlin J, Charleston J, Champagne CM, Bauck A, Ard JD, Aicher K. Comparison of strategies for sustaining weight loss: the weight loss maintenance randomized controlled trial. JAMA 2008; 299:1139-48. [PMID: 18334689 DOI: 10.1001/jama.299.10.1139] [Citation(s) in RCA: 526] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
CONTEXT Behavioral weight loss interventions achieve short-term success, but re-gain is common. OBJECTIVE To compare 2 weight loss maintenance interventions with a self-directed control group. DESIGN, SETTING, AND PARTICIPANTS Two-phase trial in which 1032 overweight or obese adults (38% African American, 63% women) with hypertension, dyslipidemia, or both who had lost at least 4 kg during a 6-month weight loss program (phase 1) were randomized to a weight-loss maintenance intervention (phase 2). Enrollment at 4 academic centers occurred August 2003-July 2004 and randomization, February-December 2004. Data collection was completed in June 2007. INTERVENTIONS After the phase 1 weight-loss program, participants were randomized to one of the following groups for 30 months: monthly personal contact, unlimited access to an interactive technology-based intervention, or self-directed control. Main Outcome Changes in weight from randomization. RESULTS Mean entry weight was 96.7 kg. During the initial 6-month program, mean weight loss was 8.5 kg. After randomization, weight regain occurred. Participants in the personal-contact group regained less weight (4.0 kg) than those in the self-directed group (5.5 kg; mean difference at 30 months, -1.5 kg; 95% confidence interval [CI], -2.4 to -0.6 kg; P = .001). At 30 months, weight regain did not differ between the interactive technology-based (5.2 kg) and self-directed groups (5.5 kg; mean difference -0.3 kg; 95% CI, -1.2 to 0.6 kg; P = .51); however, weight regain was lower in the interactive technology-based than in the self-directed group at 18 months (mean difference, -1.1 kg; 95% CI, -1.9 to -0.4 kg; P = .003) and at 24 months (mean difference, -0.9 kg; 95% CI, -1.7 to -0.02 kg; P = .04). At 30 months, the difference between the personal-contact and interactive technology-based group was -1.2 kg (95% CI -2.1 to -0.3; P = .008). Effects did not differ significantly by sex, race, age, and body mass index subgroups. Overall, 71% of study participants remained below entry weight. CONCLUSIONS The majority of individuals who successfully completed an initial behavioral weight loss program maintained a weight below their initial level. Monthly brief personal contact provided modest benefit in sustaining weight loss, whereas an interactive technology-based intervention provided early but transient benefit. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00054925.
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Affiliation(s)
- Laura P Svetkey
- Division of Nephrology, Department of Medicine, Duke Hypertension Center and Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina 27710, USA.
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Stevens VJ, Funk KL, Brantley PJ, Erlinger TP, Myers VH, Champagne CM, Bauck A, Samuel-Hodge CD, Hollis JF. Design and implementation of an interactive website to support long-term maintenance of weight loss. J Med Internet Res 2008; 10:e1. [PMID: 18244892 PMCID: PMC2483846 DOI: 10.2196/jmir.931] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2007] [Revised: 11/28/2007] [Accepted: 01/04/2008] [Indexed: 01/22/2023] Open
Abstract
Background For most individuals, long-term maintenance of weight loss requires long-term, supportive intervention. Internet-based weight loss maintenance programs offer considerable potential for meeting this need. Careful design processes are required to maximize adherence and minimize attrition. Objective This paper describes the development, implementation and use of a Web-based intervention program designed to help those who have recently lost weight sustain their weight loss over 1 year. Methods The weight loss maintenance website was developed over a 1-year period by an interdisciplinary team of public health researchers, behavior change intervention experts, applications developers, and interface designers. Key interactive features of the final site include social support, self-monitoring, written guidelines for diet and physical activity, links to appropriate websites, supportive tools for behavior change, check-in accountability, tailored reinforcement messages, and problem solving and relapse prevention training. The weight loss maintenance program included a reminder system (automated email and telephone messages) that prompted participants to return to the website if they missed their check-in date. If there was no log-in response to the email and telephone automated prompts, a staff member called the participant. We tracked the proportion of participants with at least one log-in per month, and analyzed log-ins as a result of automated prompts. Results The mean age of the 348 participants enrolled in an ongoing randomized trial and assigned to use the website was 56 years; 63% were female, and 38% were African American. While weight loss data will not be available until mid-2008, website use remained high during the first year with over 80% of the participants still using the website during month 12. During the first 52 weeks, participants averaged 35 weeks with at least one log-in. Email and telephone prompts appear to be very effective at helping participants sustain ongoing website use. Conclusions Developing interactive websites is expensive, complex, and time consuming. We found that extensive paper prototyping well in advance of programming and a versatile product manager who could work with project staff at all levels of detail were essential to keeping the development process efficient. Trial Registration clinicaltrials.gov NCT00054925
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Affiliation(s)
- Victor J Stevens
- Kaiser Permanente, Center for Health Research, Portland, OR 97227, USA
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