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BACKGROUND/RATIONALE:
Obesity is one of the major health threats in the United State. It is the second leading cause of preventable death, exceeded only by tobacco dependence. A number of clinical practice guidelines and consensus statements have been issued on the management and treatment of obesity, and health care professionals are being urged to prevent and treat obesity more aggressively. Little research, however, has documented the care that is actually provided to overweight and obese patients in routine clinical practice or examined the impact of care on weight and other clinical outcomes. Recent information suggests that there are important regional variations in the care that is provided to overweight and obese patients served by the Veterans Health Administration. The VA's National Center for Health Promotion and Disease Prevention has recently developed and implemented a multidisciplinary, evidence-based stepped-care program, Managing Overweight/Obesity in Veterans Everywhere (MOVE!) to improve the quality of care for obesity. Our conceptual model of diffusion of obesity care practices links structure, process, and outcome measures that may affect or be affected by adoption of recommended obesity care practices. This proposal represents a collaboration between HSR&D investigators and clinicians from 6 VISNs and staff of the VA's National Center for Health Promotion and Disease Prevention.
OBJECTIVE(S):
The overall goals of the proposed study are to: 1) describe variations in the provision of obesity care practices in the VHA and examine system, provider, and patient level factors that predict these variations; 2) examine the impact of obesity care practices on weight and other important clinical outcomes; and 3) identify longitudinal patterns (latent classes) of weight trends over time and predictors of latent class membership.
METHODS:
The project will identify an inception cohort of obese primary care patients in FY 2002 (based upon height and weight recorded in CPRS) in VISNs 2, 8, 10, 17, 20, and 23, and follow the cohort over a 4-year period (FY 2003-2006) to examine variations in the delivery of obesity care, predictors of variations in care, and impact of obesity care practices on patient-level outcomes. By including indicators for VISN-level support for MOVE!, level of implementation of MOVE! at each facility, and individual patient exposure to MOVE!, we will be able to examine the impact of the MOVE! program on BMI and other patient outcomes. Obesity care will include: screening for obesity (documentation of heights and weights in the Vitals/Measurement application package of CPRS); recognition of obesity as a disease (primary or secondary encounter diagnosis of obesity for patients with a body mass index (BMI) > 30), and provision of the following 5 obesity care practices [nutrition counseling by dietitian, exercise class or therapy, weight management program, pharmacological interventions for obesity, and bariatric surgery]. Heights and weights will be obtained from the VHA's Corporate Data Warehouse and validated against heights and weights obtained directly from VistA or from data repositories derived from VistA. The remaining data will be extracted from other national administrative databases such as the VHA's National Patient Care Database and the Pharmacy Benefits Management Database.
FINDINGS/RESULTS:
From AAC utilization data, over 1,053,228 veterans were identified who had 1 or more primary care visits in FY2002 in VISNs 2, 8, 10, 17, 20, and 23. Of these, 844,066 had both a height and weight recorded in FY2002 and an additional 89,016 patients had a weight recorded in FY2002 and a height recorded in a later year (total N=933,082). Of these, 371,848 (39.9%) met BMI criteria for obesity based upon highest weight recorded in FY2002 and lowest height recorded in FY2002 (or FY2003-2006 if missing in FY2002). Validation work suggests that the CDW appears to reliably reflect heights and weights recorded in VistA/VISN-level soruces, but that data entry errors are present in both data sources.
IMPACT:
Study findings will provide invaluable information to the VHA, whose National Leadership Board recently recognized the problem of obesity in the veteran population as one of its top 15 priorities. Findings from the validation study were presented as part of a VIReC-sponsored workshop on the CDW at the 2008 HSR&D National Meeting.
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases, Health Services and Systems
DRE:
Quality of Care, Prevention, Treatment
Keywords:
Behavior (provider), Practice patterns, Obesity
MeSH Terms:
none
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