Maintaining Activity and Nutrition through Technology-Assisted Innovation in Primary Care (Pennsylvania)

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Summary:

Obesity is often a chronic lifelong condition and most individuals who reduce body weight through lifestyle interventions, such as diet and physical activity, regain weight. Sustained lifestyle support and consistent self-monitoring of behaviors and weight are key strategies for promoting successful maintenance of weight loss. Thus, self-monitoring interventions that leverage the long-term relationships that patients share with their primary care physicians (PCPs) for support in maintaining lifestyle changes could address this problem.

The research team conducted the Maintaining Activity and Nutrition through Technology-Assisted Innovation in Primary Care (MAINTAIN-pc) randomized controlled trial using an electronic health record (EHR)-based intervention to help patients successfully maintain recent intentional weight loss. The intervention provided health coaching to participants via a patient portal and progress reports to PCPs via the EHR. EHR-based delivery of the intervention is notable, as it facilitates real-time clinical updates coordinated with routine care. Participants were recruited through the University of Pittsburgh Medical Center, where PCPs approved patient enrollment into the study.

The specific aim of the project was as follows:

  • Determine the efficacy of online coaching and electronic progress reports delivered through the portal to support weight maintenance after initial weight loss of at least 5 percent body weight. 

The trial enrolled 98 coaching intervention patients and 96 control patients. All participants received information on the EHR-based tracking tools, healthy eating, and safe physical activity; they also received weekly reminders to track weight, diet, and physical activity in the portal. Participants randomized to the intervention additionally received 2 years of personalized health coaching through the EHR patient portal, where coaches sent questionnaires and health promotion information, and answered questions. PCPs for the intervention group received real-time progress reports with counseling tips to help support patient weight loss, notification of weight change of greater than 10 pounds from enrollment weight, and annual progress reports at 12 and 24 months, all delivered via the EHR.

Outcomes were measured at baseline and 6, 12, and 24 months. Compared to the control participants, intervention participants regained less weight at each assessment. At 24 months, 65 percent of intervention and 49 percent of control patients had maintained the 5 percent weight loss. There were no differences, however, between groups in waist circumference, pedometer steps, or blood pressure. Findings indicate that EHRs can be adapted for weight maintenance coaching without excessive cost or programming requirements. Future research is needed to assess longer-term effectiveness, generalizability, and cost-effectiveness of the intervention.

Maintaining Activity and Nutrition through Technology-Assisted Innovation in Primary Care - 2012

Summary Highlights

  • Principal Investigator: 
  • Funding Mechanism: 
    PA: 09-07: AHRQ Health Services Research Demonstration and Dissemination Grants (R18)
  • Grant Number: 
    R18 HS 021162
  • Project Period: 
    September 2012 – July 2017
  • AHRQ Funding Amount: 
    $2,366,675
  • PDF Version: 
    (PDF, 193.47 KB)

Summary: Most individuals who reduce body weight through lifestyle interventions, such as diet and physical activity, regain weight. Only about 20 percent of overweight or obese people are able to lose at least 10 percent of their body weight and keep it off for at least 1 year. Therefore, obesity tends to be a chronic, lifelong condition. Despite the fact that obesity is associated with a host of medical diseases, weight interventions are usually conducted in a vacuum, separate from participants’ usual medical care and without input from the primary care team.

Virtual Lifestyle Management (VLM) is an intervention previously developed by the research team that uses health information technology (IT) to promote weight loss among primary care patients. This project will extend the work of VLM to include evaluation of health IT tools designed to promote weight maintenance and prevent relapse in primary care patients who have lost weight. The research leverages technology such as online visits and electronic health records (EHRs) to enable primary care sites to contact patients and track their progress in ongoing weight maintenance efforts.

Building on previous work by the research team, this project is developing health IT tools to promote weight maintenance in the primary care setting. The project will conduct a randomized clinical trial to test whether online tracking tools, weight maintenance “coaching” visits for patients, and “real time” electronic progress reports for primary care physicians (PCPs) will support more successful weight maintenance than online tracking tools alone in a group of primary care patients who have lost greater or equal to 5 percent of their body weight. The online coaching visits for participants will be delivered through the primary care site’s electronic patient portal and the electronic progress reports for PCPs delivered through the EHR.

The project will assess multiple relevant outcomes across clinically meaningful treatment strategies. The team will recruit a sample that reflects the racial and ethnic mix of the region and is diverse in terms of gender, body mass index, and co-morbidity status. The team will include clinical practices with diverse characteristics and will have interventionists who reflect the level of training typically seen among primary care clinic staff. They will recruit 30-40 participants a month, with recruitment lasting 5-6 months, and each participant receiving a 3-year intervention. The last year of the study will focus on analyses, including a cost-effectiveness analysis.

Specific Aims:

  • Determine the efficacy of online coaching and electronic progress reports delivered through the primary care site’s electronic health portal to support weight management after initial weight loss of greater or equal to 5 percent. (Ongoing)
  • Evaluate whether online weight maintenance tools will be acceptable to patients and PCPs when integrated into routine clinical workflow, and assess barriers to patient and PCP uptake. (Upcoming)
  • Determine the cost effectiveness of online coaching and electronic progress reports delivered through the primary care site’s electronic health portal. (Upcoming)

2012 Activities: The project focused on start-up activities including hiring of staff, preparation of the institutional review board submission, and writing of the protocol and manual of procedures. The team held regular meetings with IT staff to develop online tracking and coaching tools, and with the intervention team to develop and refine the intervention content. As last self-reported in the AHRQ Research Reporting System, project progress and activities are on track in some respects but not others and budget funds are slightly underspent because of staff hire delays. However, Dr. Conroy is confident that all positions will be filled and the budget reconciled over time.

Preliminary Impact and Findings: The project has no findings to date.

Target Population: Chronic Care*, Low SES/Low Income*, Obesity, Racial or Ethnic Minorities*, Women*

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to improve health care decisionmaking through the use of integrated data and knowledge management.

Business Goal: Implementation and Use

* This target population is one of AHRQ’s priority populations.

Maintaining Activity and Nutrition Through Technology-Assisted Innovation in Primary Care - Final Report

Citation:
McTigue K. Maintaining Activity and Nutrition Through Technology-Assisted Innovation in Primary Care - Final Report. (Prepared by the University of Pittsburgh under Grant No. R18 HS021162). Rockville, MD: Agency for Healthcare Research and Quality, 2018. (PDF, 384.6 KB)

The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. (Persons using assistive technology may not be able to fully access information in this report. For assistance, please contact Corey Mackison)
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