PCORI funds implementation projects to promote the use of findings from PCORI-funded studies. This project focuses on implementing findings from the completed PCORI-funded research project: Testing an Online Program with and without Health Management Support to Help Patients Manage Their Weight
1. What were the results from the original PCORI-funded research study?
In the PROPS Study (Partnerships for Reducing Overweight and Obesity with Patient-centered Strategies), the project team adapted an online weight management program and combined it with population health management support, which was additional monitoring and outreach from non-clinical staff members who worked with the primary care practices. The team compared the effectiveness of the combined intervention (including the online program plus population health management) with the online program only and with usual care among primary care patients with overweight or obesity and either hypertension or type 2 diabetes. There was a statistically significant difference in weight loss at 12 months by group, with average weight loss of 1.2 kilograms, 1.9 kilograms, and 3.1 kilograms in the usual care, online only, and combined intervention groups, respectively. Percent weight change also differed significantly by group; 14.9 percent of patients in the usual care group, 20.8 percent of patients in the online only group, and 32.3 percent of patients in the combined group lost at least 5 percent of their initial body weight at 12 months. Furthermore, patients in the combined intervention group were able to maintain their weight loss at 18 months.
2. Why is this research finding important?
Patients in the combined intervention group had significantly greater weight loss at 12 months compared with patients in the online-only group or the usual care group. These results are consistent with previous studies showing that online programs can help patients with weight loss, but this was the first study to demonstrate that an online program can be integrated with population health management support, delivered by non-clinical staff, and implemented in routine primary care. Although the amount of weight loss was small, the intervention could have a large effect on population health if it is scalable. It is now critical to expand these findings to a broader population of patients and settings, to maximize the reach of the intervention. Given that over two-thirds of adults in the United States have overweight or obesity, this project could have an important impact on the health of many patients.
3. What is the goal of this project?
The goal of this project is to adapt and implement the intervention from the PROPS Study on a larger scale, in a broader patient population and a variety of settings. To accomplish this goal, the team will engage with various stakeholders to adapt the combined intervention from the PROPS Study, implement the intervention across multiple settings and a diverse cross-section of patients and clinicians affiliated with Brigham and Women’s Hospital (BWH), evaluate the impact of the implementation, and create an implementation guide for others to use in the future.
4. What is the project team doing?
Before implementation, the team will engage with stakeholders and obtain feedback from patients and clinicians that will be used to refine the intervention; the team also will identify clinician champions at each site who will assist with implementation. During implementation, the team will conduct trainings with clinicians and direct outreach to patients about the intervention. Patient navigators from the Digital Care Transformation team will contact patients, enroll them in the online program, monitor their progress, and help connect them with other resources and services for weight management at BWH and in the community. The target audience includes adult patients with body mass index (BMI) ≥ 30 kg/m2 and those with BMI of 25 to 29.9 kg/m2 plus indicators of increased cardiovascular risk. The intervention will be implemented in BWH clinical and community sites that are most likely to see patients who would benefit from weight loss, including primary care, cardiology, endocrinology, orthopedic surgery, comprehensive breast health, and the Center for Community Wellness. The intervention has the potential to affect care for over 100,000 eligible patients across these sites. The goal is to enroll at least 5,000 patients during the implementation period. This project will improve management of overweight and obesity in clinical and community settings, and ultimately, improve outcomes among patients with overweight or obesity.
5. How is the team evaluating this project?
The team will evaluate the reach, effectiveness, adoption, and implementation, and maintenance of the intervention, using data from the electronic health record, online program, patient and clinician surveys, and focus groups and interviews. For reach, the team will assess the number/proportion of eligible patients who are referred to the intervention. For effectiveness, the team will assess changes in patients’ weight and other outcomes at 12 months, as well as changes in clinicians’ knowledge, attitudes, and behaviors about management of overweight and obesity. For adoption, the team will assess the number/proportion of patients who enroll in the online program and/or connect with a navigator. For implementation, the team will assess the number/frequency of patient logins to the online program and contacts with a navigator. For maintenance, the team will assess the number/proportion of patients who are referred to the intervention six months after the end of active implementation activities, as well as patients’ weight loss at 18 months. The team also will assess patient and clinician satisfaction with the intervention and any barriers or facilitators to implementation.
6. How is the team involving patients and others in making sure the findings reach people who can use them?
The project has a strong team of co-investigators, patients, and stakeholders who are highly committed and well-prepared to ensure successful implementation of the intervention. For example, Benjamin Scirica, MD, is the leader of the Digital Care Transformation team, which has developed and implemented a series of remote disease management programs for hypertension and hyperlipidemia; he has committed the patient navigators from their team to help deliver the intervention for this project. Caroline Apovian, MD, and Ali Tavakkoli, MD (Co-Directors of the Center for Weight Management and Wellness) have committed to setting up pathways to connect patients with other resources and services for weight management. In addition, the team has representatives from several regional and national organizations such as The Obesity Society (Anthony Comuzzie, PhD), the Obesity Action Coalition (Joe Nadglowski), AllWays Health Partners (Farah Shafi, MD), and the Society for General Internal Medicine (Melissa Wei, MD), who will help circulate the findings to a broad audience. The team also has stakeholders from each of the implementation sites, as well as several patient advisors who were involved in the PROPS Study. The team will hold monthly meetings of the Patient and Stakeholder Advisory Council, and members will be involved in activities at each stage of the project.
7. How will this project help ensure future uptake and use of findings from patient-centered outcomes research?
Collaborating with the Digital Care Transformation team and the Center for Weight Management and Wellness to deliver this intervention will help maximize its scalability and sustainability in the future. Furthermore, the team will develop an implementation guide that will provide detailed instructions about all aspects of the project for those who may wish to implement the intervention at other sites in the future, which will increase future reach and uptake. It will describe the intervention (including the online program and patient navigator protocol) and the implementation process (e.g., integration with the electronic health record, recruitment of clinician champions, trainings). It will also include results about the success of the implementation, as well as any barriers and facilitators. Members of the Patient and Stakeholder Advisory Council will be involved in creating the guide as well as distributing it to a national audience.
Initial PCORI-Funded Research Study
This implementation project focuses on putting findings into practice from this completed PCORI-funded research study: Testing an Online Program with and without Health Management Support to Help Patients Manage Their Weight