1
|
Brown SD, Garcia BL, Ritchie JL, Tsai AL, Millman A, Greenberg M, Quesenberry CP, Ferrara A. Digital health outreach to promote postpartum screening after gestational diabetes: A randomized factorial pilot study. PEC INNOVATION 2024; 4:100256. [PMID: 38282680 PMCID: PMC10818066 DOI: 10.1016/j.pecinn.2024.100256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 12/18/2023] [Accepted: 01/17/2024] [Indexed: 01/30/2024]
Abstract
Objective We examined the acceptability and feasibility of a multi-component digital health outreach intervention to promote uptake of guideline-recommended postpartum screening for type 2 diabetes among patients with gestational diabetes (GDM). Methods We conducted a 24 randomized factorial experiment as part of the Multiphase Optimization Strategy (MOST) preparation phase for developing behavioral interventions. Participants with current or recent GDM in an integrated healthcare system were randomized to receive an outreach message with up to four intervention components, designed to be self-administered in about 10 min and efficiently delivered online via REDCap: a streamlined values affirmation, personalized information on diabetes risk, an interactive motivational interviewing-based component, and an interactive action planning component. Patient-reported acceptability and feasibility outcomes were assessed via survey. Results Among 162 participants, 72% self-identified with a racial/ethnic minority group. Across components, acceptability scores averaged 3.9/5; ≥91% of participants read most or all of the outreach message; ≥89% perceived the amount of information as "about right"; and ≥ 87% completed ≥1 interactive prompt. Conclusion Each intervention component was acceptable to diverse patients and feasible to deliver in a brief, self-directed, online format. Innovation These novel components target unaddressed barriers to patient engagement in guideline-recommended postpartum diabetes screening and adapt theory-based behavior change techniques for large-scale use.
Collapse
Affiliation(s)
- Susan D. Brown
- Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Brittany L. Garcia
- Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA
| | - Jenna L. Ritchie
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Ai-Lin Tsai
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Andrea Millman
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Mara Greenberg
- Regional Perinatal Service Center, Kaiser Permanente Northern California, Oakland, CA, USA
| | | | - Assiamira Ferrara
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| |
Collapse
|
2
|
Spring B, Garcia SF, Daly E, Jacobs M, Jayeoba M, Jordan N, Kircher S, Kocherginsky M, Mazzetta R, Pollack T, Scanlan L, Scherr C, Hitsman B, Phillips SM. Scalable Telehealth Cancer Care: integrated healthy lifestyle program to live well after cancer treatment. J Natl Cancer Inst Monogr 2024; 2024:83-91. [PMID: 38924795 PMCID: PMC11207740 DOI: 10.1093/jncimonographs/lgae020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/13/2024] [Accepted: 04/16/2024] [Indexed: 06/28/2024] Open
Abstract
Northwestern University's Center for Scalable Telehealth Cancer Care (STELLAR) is 1 of 4 Cancer Moonshot Telehealth Research Centers of Excellence programs funded by the National Cancer Institute to establish an evidence base for telehealth in cancer care. STELLAR is grounded in the Institute of Medicine's vision that quality cancer care includes not only disease treatment but also promotion of long-term health and quality of life (QOL). Cigarette smoking, insufficient physical activity, and overweight and obesity often co-occur and are associated with poorer treatment response, heightened recurrence risk, decreased longevity, diminished QOL, and increased treatment cost for many cancers. These risk behaviors are prevalent in cancer survivors, but their treatment is not routinely integrated into oncology care. STELLAR aims to foster patients' long-term health and QOL by designing, implementing, and sustaining a novel telehealth treatment program for multiple risk behaviors to be integrated into standard cancer care. Telehealth delivery is evidence-based for health behavior change treatment and is well suited to overcome access and workflow barriers that can otherwise impede treatment receipt. This paper describes STELLAR's 2-arm randomized parallel group pragmatic clinical trial comparing telehealth-delivered, coach-facilitated multiple risk behavior treatment vs self-guided usual care for the outcomes of reach, effectiveness, and cost among 3000 cancer survivors who have completed curative intent treatment. This paper also discusses several challenges encountered by the STELLAR investigative team and the adaptations developed to move the research forward.
Collapse
Affiliation(s)
- Bonnie Spring
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
- Robert H Lurie Comprehensive Cancer Center, Chicago, IL 60611, USA
- Department of Psychiatry & Behavioral Sciences, Northwestern University, Chicago, IL 60611, USA
| | - Sofia F Garcia
- Robert H Lurie Comprehensive Cancer Center, Chicago, IL 60611, USA
- Department of Psychiatry & Behavioral Sciences, Northwestern University, Chicago, IL 60611, USA
- Department of Medical Social Sciences, Northwestern University, Chicago, IL 60611, USA
| | - Elyse Daly
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Maia Jacobs
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
- Department of Computer Science, Northwestern University, Evanston, IL 60208, USA
| | - Monisola Jayeoba
- Department of Communication Studies, Northwestern University, Evanston, IL 60208, USA
| | - Neil Jordan
- Department of Psychiatry & Behavioral Sciences, Northwestern University, Chicago, IL 60611, USA
- Department of Medical Social Sciences, Northwestern University, Chicago, IL 60611, USA
| | - Sheetal Kircher
- Robert H Lurie Comprehensive Cancer Center, Chicago, IL 60611, USA
- Department of Medicine, Northwestern University, Chicago, IL 60611, USA
- Hematology Oncology, Northwestern Medicine, Chicago, IL 60611, USA
| | - Masha Kocherginsky
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
- Robert H Lurie Comprehensive Cancer Center, Chicago, IL 60611, USA
| | - Rana Mazzetta
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Teresa Pollack
- Quality Division, Northwestern Medicine, Chicago, IL 60611, USA
| | - Laura Scanlan
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Courtney Scherr
- Robert H Lurie Comprehensive Cancer Center, Chicago, IL 60611, USA
- Department of Communication Studies, Northwestern University, Evanston, IL 60208, USA
| | - Brian Hitsman
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
- Robert H Lurie Comprehensive Cancer Center, Chicago, IL 60611, USA
| | - Siobhan M Phillips
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
- Robert H Lurie Comprehensive Cancer Center, Chicago, IL 60611, USA
| |
Collapse
|
3
|
Sforzo GA, Kaye MP, Faber A, Moore M. Dosing of Health and Wellness Coaching for Obesity and Type 2 Diabetes: Research Synthesis to Derive Recommendations. Am J Lifestyle Med 2023; 17:374-385. [PMID: 37304739 PMCID: PMC10248368 DOI: 10.1177/15598276211073078] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023] Open
Abstract
Health and wellness coaching (HWC) is an effective intervention for lifestyle disease such as obesity and type 2 diabetes. The evolving HWC profession needs recommendations to guide clinical practice, particularly the appropriate dose of coaching. The purpose of this paper was to systematically review and synthesize HWC literature to derive HWC programming recommendations. Of 102 papers retrieved, 88 were retained with data extracted determining HWC session number, frequency, duration, program length, and total coaching load. Differential analysis yielded no statistical difference in programming variables for randomized control trials and other designs, nor for studies with significant findings v. those not finding statistical significance, allowing these data to be pooled. The HWC intervention for obesity was slightly more intense (15 sessions over 7-8 mo) than the diabetes programming (12 sessions over 9-10 mo). On average, HWC programming applied in the peer-reviewed literature was 12-15 sessions of 35-40 min duration over 7-9 months. These recommendations for HWC programming variables are put forth as initial practice guidelines and should be examined with comparative effectiveness study for optimization. HWC best practice guidelines for other patient groups (e.g., heart disease, cancer, and chronic pain) should also be studied once an adequate literature data base is available.
Collapse
Affiliation(s)
- Gary A Sforzo
- Department of Exercise Science and Athletic Training, Ithaca College, Ithaca, NY, USA
| | - Miranda P Kaye
- Survey Research Center, Penn State University, University Park, PA, USA
| | - Aubrey Faber
- Department of Psychology, St John's University, Queens, NY, USA
| | - Margaret Moore
- Wellcoaches Corporation, Wellesley, MA, USA
- Institute of Coaching, McLean Hospital, Belmont, MA, USA
| |
Collapse
|
4
|
Siegel KR, Ali MK, Ackermann RT, Black B, Huguet N, Kho A, Mangione CM, Nauman E, Ross-Degnan D, Schillinger D, Shi L, Wharam JF, Duru OK. Evaluating Natural Experiments that Impact the Diabetes Epidemic: an Introduction to the NEXT-D3 Network. Curr Diab Rep 2022; 22:393-403. [PMID: 35864324 PMCID: PMC9303841 DOI: 10.1007/s11892-022-01480-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Diabetes is an ongoing public health issue in the USA, and, despite progress, recent reports suggest acute and chronic diabetes complications are increasing. RECENT FINDINGS The Natural Experiments for Translation in Diabetes 3.0 (NEXT-D3) Network is a 5-year research collaboration involving six academic centers (Harvard University, Northwestern University, Oregon Health & Science University, Tulane University, University of California Los Angeles, and University of California San Francisco) and two funding agencies (Centers for Disease Control and Prevention and National Institutes of Health) to address the gaps leading to persisting diabetes burdens. The network builds on previously funded networks, expanding to include type 2 diabetes (T2D) prevention and an emphasis on health equity. NEXT-D3 researchers use rigorous natural experiment study designs to evaluate impacts of naturally occurring programs and policies, with a focus on diabetes-related outcomes. NEXT-D3 projects address whether and to what extent federal or state legislative policies and health plan innovations affect T2D risk and diabetes treatment and outcomes in the USA; real-world effects of increased access to health insurance under the Affordable Care Act; and the effectiveness of interventions that reduce barriers to medication access (e.g., decreased or eliminated cost sharing for cardiometabolic medications and new medications such as SGLT-2 inhibitors for Medicaid patients). Overarching goals include (1) expanding generalizable knowledge about policies and programs to manage or prevent T2D and educate decision-makers and organizations and (2) generating evidence to guide the development of health equity goals to reduce disparities in T2D-related risk factors, treatment, and complications.
Collapse
Affiliation(s)
- Karen R Siegel
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Mohammed K Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Ronald T Ackermann
- Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bernard Black
- Pritzker School of Law, Institute for Policy Research, and Kellogg School of Management, Northwestern University, Evanston, IL, USA
| | - Nathalie Huguet
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Abel Kho
- Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Carol M Mangione
- David Geffen School of Medicine at UCLA and Fielding School of Public Health, UCLA, Los Angeles, CA, USA
| | | | - Dennis Ross-Degnan
- Duke University Department of Medicine and Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | - Dean Schillinger
- Division of General Internal Medicine and Center for Vulnerable Populations, San Francisco General Hospital and University of California San Francisco, San Francisco, CA, USA
| | - Lizheng Shi
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - J Frank Wharam
- Duke University Department of Medicine and Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | - O Kenrik Duru
- David Geffen School of Medicine at UCLA and Fielding School of Public Health, UCLA, Los Angeles, CA, USA
| |
Collapse
|
5
|
Sarabia-Cobo C, Pérez V, de Lorena P, Sáenz-Jalón M, Alconero-Camarero AR. Effectiveness of a telephone intervention based on motivational health coaching for improving the mental health of caregivers of people with dementia: A randomised controlled trial. Int J Older People Nurs 2021; 16:e12398. [PMID: 34337869 DOI: 10.1111/opn.12398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 03/17/2021] [Accepted: 06/01/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Caring for a family member with dementia is considered one of the activities with the greatest negative impact on a person's mental health. Developing long-lasting and effective strategies is a challenge for caregivers. This study sought to evaluate the impact of an intervention based on a programme of motivational coaching delivered by telephone in a group of caregivers of patients with dementia compared to a control group. METHODS A randomised controlled trial with a control group and an intervention group. (CONSORT guidelines were used). Telephone calls were made during six weeks, involving a process of coaching and motivational interviews. The following variables were measured in caregivers: self-efficacy of caring, depression, perceived stress, frequency of problematic behaviours and dysfunctional thoughts. Assessments were conducted at three time points: baseline, post-intervention and three months' post-intervention. RESULTS In total, 106 caregivers participated (53 subjects in the control group and 53 in the intervention group). Statistically significant differences (ANCOVA) were found between both groups for the self-efficacy and stress variables, with improved results in the intervention group (p < .01). Furthermore, statistically significant differences were found in the intervention group between the baseline and post-intervention assessments, with improvements in self-efficacy, decreased stress and decreased dysfunctional thoughts (p < .05). The results were maintained over time for both groups. CONCLUSIONS An intervention based on telephone calls using a health coaching approach with motivational interviewing appears to be effective for the improvement of self-efficacy and mental health of caregivers of people with moderate dementia. Furthermore, these effects appear to be maintained over time.
Collapse
Affiliation(s)
- Carmen Sarabia-Cobo
- Nursing Research Group IDIVAL, Faculty of Nursing, University of Cantabria, Santander, Spain
| | | | | | - María Sáenz-Jalón
- Hospital 12 de Octubre, Nursing Research Group IDIVAL, Madrid, Spain
| | | |
Collapse
|
6
|
Badon SE, Nance N, Fogelberg R, Quesenberry C, Hedderson MM, Avalos LA. Lifestyle-related education and counseling resource utilization and cardiovascular biomarkers in midlife women with low physical activity. Prev Med Rep 2021; 23:101401. [PMID: 34123714 PMCID: PMC8173299 DOI: 10.1016/j.pmedr.2021.101401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/21/2021] [Accepted: 05/12/2021] [Indexed: 11/30/2022] Open
Abstract
3% of high-risk midlife women participated in lifestyle-related resources. Lifestyle-related resource use was associated with more physical activity. Lifestyle-related resource use was associated with lower weight in obese women. Lifestyle-related resource use was associated with lower glucose in some women.
Health plan-based resources are promising avenues for decreasing cardiovascular disease risk. This study examined associations of lifestyle-related resource utilization within a healthcare delivery system and cardiovascular biomarkers among midlife women with low physical activity. Midlife women (45-55 years old) with <10 min/week of reported physical activity at a primary care visit within a large integrated healthcare delivery system in Northern California in 2015 (n = 55,393) were identified. Within this cohort, subsequent lifestyle-related health education and individual coaching resource utilization, and the next recorded physical activity, weight, systolic blood pressure, plasma glucose, HDL and LDL cholesterol measures up to 2 years after the index primary care visit were identified from electronic health records. We used a multilevel linear model to estimate associations. About 3% (n = 1587) of our cohort had ≥1 lifestyle-related resource encounter; 0.3% (n = 178) had ≥ 4 encounters. Participation in ≥4 lifestyle-related resource encounters (compared to none) was associated with 51 more minutes/week of physical activity (95% CI: 33,69) at the next clinical measurement in all women, 6.2 kg lower weight (95% CI: −7.0,-5.5) at the next measurement in women with obesity, and 8–10 mg/dL lower plasma glucose (95% CI: −30,14 and −23,2, respectively) at the next measurement in women with diabetes or prediabetes. Our results support the sustained utilization of health plan-based lifestyle-related resources for improving physical activity, weight, and plasma glucose in high-risk midlife women. Given the observed low utilization, health system-wide efforts may be warranted to increase utilization of lifestyle-related resources in this population.
Collapse
Affiliation(s)
- Sylvia E Badon
- Kaiser Permanente Northern California Division of Research, Oakland CA, United States
| | - Nerissa Nance
- Kaiser Permanente Northern California Division of Research, Oakland CA, United States
| | | | - Charles Quesenberry
- Kaiser Permanente Northern California Division of Research, Oakland CA, United States
| | - Monique M Hedderson
- Kaiser Permanente Northern California Division of Research, Oakland CA, United States
| | - Lyndsay A Avalos
- Kaiser Permanente Northern California Division of Research, Oakland CA, United States
| |
Collapse
|
7
|
Onaade O, Maples JM, Rand B, Fortner KB, Zite NB, Ehrlich SF. Physical activity for blood glucose control in gestational diabetes mellitus: rationale and recommendations for translational behavioral interventions. Clin Diabetes Endocrinol 2021; 7:7. [PMID: 33896420 PMCID: PMC8074463 DOI: 10.1186/s40842-021-00120-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/15/2021] [Indexed: 12/12/2022] Open
Abstract
Gestational Diabetes Mellitus (GDM) is associated with adverse health outcomes during pregnancy and beyond. Previous randomized controlled trials of exercise interventions have demonstrated that exercise, conducted primarily during supervised sessions, improves maternal glycemic control in women with GDM. However, additional research is needed to develop physical activity interventions that are easily implemented in healthcare settings (e.g., recommendations and strategies to increase non-supervised physical activity). This narrative review presents: current physical activity recommendations for pregnancy and women with GDM; the scientific literature to date on physical activity, particularly walking, and blood glucose control in GDM; rationale for physical activity interventions targeting women with GDM that are appropriate for translation to the clinical setting (e.g., lifestyle interventions that include behavioral counseling with a health coach); and the strategies employed by previous, successful lifestyle interventions for pregnant and postpartum women that were based in clinical settings.Most previous exercise interventions for blood glucose control in women with GDM have included supervised exercise sessions, and will thus be difficult to translate to the health care system. However, lifestyle interventions for weight maintenance (i.e., healthy diet and physical activity) set in the health care system and delivered by health coaches have been successfully implemented in pregnant and postpartum populations. Therefore, we suggest that future trials examine lifestyle interventions that promote unsupervised walking with evidence-based behavioral strategies (e.g., goal setting, monitoring, and feedback) and consider incorporating the use of physical activity tracking devices to support these strategies.
Collapse
Affiliation(s)
- Oluwafemifola Onaade
- Department of Public Health, The University of Tennessee, 369 HPER, 1914 Andy Holt Ave., TN, 37996, Knoxville, USA.
| | - Jill M Maples
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tennessee, Knoxville, TN, USA
| | - Bethany Rand
- Department of Public Health, The University of Tennessee, 369 HPER, 1914 Andy Holt Ave., TN, 37996, Knoxville, USA
| | - Kimberly B Fortner
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tennessee, Knoxville, TN, USA
| | - Nikki B Zite
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tennessee, Knoxville, TN, USA
| | - Samantha F Ehrlich
- Department of Public Health, The University of Tennessee, 369 HPER, 1914 Andy Holt Ave., TN, 37996, Knoxville, USA
| |
Collapse
|
8
|
Speaker SL, Rastogi R, Sussman TA, Hu B, Misra-Hebert AD, Rothberg MB. Treatment of Patients with Prediabetes in a Primary Care Setting 2011-2018: an Observational Study. J Gen Intern Med 2021; 36:923-929. [PMID: 33449282 PMCID: PMC8041989 DOI: 10.1007/s11606-020-06354-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 11/18/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Over one third of American adults are at high risk for developing diabetes, which can be delayed or prevented using interventions such as medical nutrition therapy (MNT) or metformin. Physicians' self-reported rates of prediabetes treatment are improving, but patterns of actual referral, prescription, and MNT visits are unknown. OBJECTIVE To characterize treatment of prediabetes in primary care. DESIGN We conducted a retrospective cohort study using electronic health record data. We described patterns of treatment and used multivariable logistic regression to evaluate the association of patient factors and PCP-specific treatment rate with patient treatment. PATIENTS We included overweight or obese outpatients who had a first prediabetes-range hemoglobin A1c (HbA1c) during 2011-2018 and had primary care provider (PCP) follow-up within a year. MAIN MEASURES We collected patient characteristics and the following treatments: metformin prescription; referral to MNT, diabetes education, endocrinology, or bariatric medicine; and MNT visit. We did not capture within-visit physician counseling. KEY RESULTS Of 16,713 outpatients with prediabetes, 20.4% received treatment, including metformin prescriptions (7.8%) and MNT referrals (11.3%), but only 7.4% of referred patients completed a MNT visit. The strongest predictor of treatment was the patient's PCP's treatment rate. Some PCPs never treated prediabetes, but two treated more than half of their patients; 62% had no patients complete a MNT visit. Being younger or female and having higher body mass index or HbA1c were also positively associated with treatment. Compared to white patients, black patients were more likely to receive MNT referral and less likely to receive metformin. CONCLUSIONS Almost 80% of patients with new prediabetes never received treatment, and those who did receive referrals had very poor visit completion. Treatment rates appear to reflect provider rather than patient preferences.
Collapse
Affiliation(s)
- Sidra L Speaker
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Radhika Rastogi
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | | | - Bo Hu
- Quantitative Health Services, Cleveland Clinic, Cleveland, OH, USA
| | - Anita D Misra-Hebert
- Quantitative Health Services, Cleveland Clinic, Cleveland, OH, USA
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, USA
| | - Michael B Rothberg
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA.
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, USA.
| |
Collapse
|
9
|
Bricker JB, Mull KE, Sullivan BM, Forman EM. Efficacy of telehealth acceptance and commitment therapy for weight loss: a pilot randomized clinical trial. Transl Behav Med 2021; 11:1527-1536. [PMID: 33787926 DOI: 10.1093/tbm/ibab012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Telehealth coaching for weight loss has high population-level reach but limited efficacy. To potentially improve on this limitation, the purpose of this study was to determine the preliminary efficacy of the first known telephone coaching acceptance and commitment therapy (ACT) intervention for weight loss. A two-arm, stratified, individually randomized pilot trial comparing ACT (n = 53) with standard behavioral therapy (SBT; n = 52) was used for this study. Both interventions were delivered in 25 telephone coaching calls (15-20 min each) over a 12 month period. Weight was measured at baseline and 3, 6, and 12 month postrandomization follow-ups. Recruited from 32 U.S. states, participants were of mean age 40.7, 42% male, 34% racial/ethnic minority, and mean baseline body mass index of 34.3. Fractions of 10% or more scale-reported weight loss: 15% for ACT versus 4% for SBT at 3 month follow-up (N = 86; odds ratio [OR] = 4.61; 95% confidence interval [CI]: 0.79, 26.83), 24% for ACT versus 13% for SBT at 6 month follow-up (N = 72; OR = 2.45; 95% CI: 0.65, 9.23), 30% for ACT versus 30% for SBT at 12 month follow-up (N = 57; OR = 0.93; 95% CI: 0.28, 3.09). Fractions of 10% or more self-reported weight loss at 12 month follow-up: 25% for ACT versus 15% for SBT (N = 75; OR = 2.38; 95% CI: 0.68, 8.34). The conclusion of the study was the preliminary evidence that telephone coaching ACT may be efficacious for weight loss.
Collapse
Affiliation(s)
- Jonathan B Bricker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA.,Department of Psychology, University of Washington, Seattle, WA 98195, USA
| | - Kristin E Mull
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Brianna M Sullivan
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Evan M Forman
- Department of Psychology, and Center for Weight, Eating and Lifestyle Science, Drexel University, Philadelphia, PA 19104, USA
| |
Collapse
|
10
|
Ramachandran B, Trinacty CM, Wharam JF, Duru OK, Dyer WT, Neugebauer RS, Karter AJ, Brown SD, Marshall CJ, Wiley D, Ross-Degnan D, Schmittdiel JA. A Randomized Encouragement Trial to Increase Mail Order Pharmacy Use and Medication Adherence in Patients with Diabetes. J Gen Intern Med 2021; 36:154-161. [PMID: 33001334 PMCID: PMC7858994 DOI: 10.1007/s11606-020-06237-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 09/10/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Mail order pharmacy (MOP) use has been linked to improved medication adherence and health outcomes among patients with diabetes. However, no large-scale intervention studies have assessed the effect of encouraging MOP use on medication adherence. OBJECTIVE To assess an intervention to encourage MOP services to increase its use and medication adherence. DESIGN Randomized encouragement trial. PATIENTS 63,012 diabetes patients from three health care systems: Kaiser Permanente Northern California (KPNC), Kaiser Permanente Hawaii (KPHI), and Harvard Pilgrim Health Care (HPHC) who were poorly adherent to at least one class of cardiometabolic medications and had not used MOP in the prior 12 months. INTERVENTION Patients were randomized to receive either usual care (control arm) or outreach encouraging MOP use consisting of a mailed letter, secure email message, and automated telephone call outlining the potential benefits of MOP use (intervention arm). HPHC intervention patients received the letter only. MEASUREMENTS We compared the percentages of patients that began using MOP and that became adherent to cardiometabolic medication classes during a 12-month follow-up period. We also conducted a race/ethnicity-stratified analysis. RESULTS During follow-up, 10.6% of intervention patients began using MOP vs. 9.3% of controls (p < 0.01); the percent of cardiometabolic medication delivered via mail was 42.1% vs. 39.8% (p < 0.01). Metformin adherence improved in the intervention arm relative to control at the two KP sites (52% vs. 49%, p < 0.01). Stratified analyses suggested a significant positive effect of the intervention in White (RR: 1.12, 95% CI: 1.03, 1.22) and Asian (RR: 1.30, 95% CI: 1.17, 1.45) patients. CONCLUSION This pragmatic trial showed that simple outreach to encourage MOP modestly increased its use and improved adherence measured by refills to a key class of diabetes medications in some settings. Given its minimal cost, clinicians and health systems should consider outreach interventions to actively promote MOP use among diabetes patients. TRIAL REGISTRATION ClinicalTrials.gov registration number: NCT02621476.
Collapse
Affiliation(s)
| | | | - J. Frank Wharam
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA USA
| | - O Kenrik Duru
- University of California, Los Angeles, Los Angeles, CA USA
| | - Wendy T. Dyer
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612 USA
| | - Romain S. Neugebauer
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612 USA
| | - Andrew J. Karter
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612 USA
| | - Susan D. Brown
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612 USA
- School of Medicine, University of California, Davis, Sacramento, CA USA
| | | | - Deanne Wiley
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612 USA
| | - Dennis Ross-Degnan
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA USA
| | - Julie A. Schmittdiel
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612 USA
| |
Collapse
|
11
|
Diet and Oral Health Coaching Methods and Models for the Independent Elderly. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10114021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Health-related behavior based on diet is an important determinant of oral health in independent elderly. Aging impairs senses, mastication, oral status, and function, causing nutritional needs and diet insufficiencies that contribute to a vicious circle of impairment. But the present needs of independent older adults suggest that health research and oral health care should shift from disease management and therapy to integral customized and personal treatment plans, including lifestyle, psychological, nutritional, and oral health coaching approaches. In this paper health coaching approaches in medical and dental settings are valued as to their effectiveness for older adults. Furthermore, coaching approaches for seniors are discussed and coaching models for better senior patient-dentist cooperation on the diet issue are suggested. Diet and oral health coaching is proven to be a modern senior patient-centered approach that needs to be incorporated at all relevant settings. It should aim to empower older adults in co-management of their oral diseases or bad diet habits affecting their oral health. This can be carried out through an incorporated educational plan for dentists either at the postgraduate or professional level since advantages seem to enhance the quality of life of the independent elderly.
Collapse
|
12
|
Ayyala MS, Coughlin JW, Martin L, Henderson J, Ezekwe N, Clark JM, Appel LJ, Bennett WL. Perspectives of pregnant and postpartum women and obstetric providers to promote healthy lifestyle in pregnancy and after delivery: a qualitative in-depth interview study. BMC Womens Health 2020; 20:44. [PMID: 32131832 PMCID: PMC7057562 DOI: 10.1186/s12905-020-0896-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 02/03/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Pregnancy provides an opportunity to promote healthy lifestyle behaviors. This study's aim was to explore the perspectives of pregnant and postpartum women and obstetric providers around behavioral lifestyle changes in pregnancy and postpartum. METHODS We conducted a qualitative study with pregnant and postpartum patients recruited from 2 prenatal care clinics at an urban, academic hospital in the United States. In-depth interviews with 23 pregnant or postpartum women and 11 obstetric providers were completed between October 2015-April 2016. Interviews were audio-recorded and transcribed verbatim. We coded transcripts for thematic content and applied the PRECEDE-PROCEED framework for results to directly inform program development. RESULTS Six themes highlighted the predisposing, enabling and reinforcing factors that enable and sustain health behavior changes in pregnancy and postpartum: 1) "Motivation to have a healthy baby" during pregnancy and to "have my body back" after delivery, 2) Pre-pregnancy knowledge and experiences about pregnancy and the postpartum period, 3) Prioritizing wellness during pregnancy and postpartum, 4) The power of social support, 5) Accountability, 6) Integration with technology to reinforce behavior change. CONCLUSIONS In this qualitative study, pregnant and postpartum women and obstetric providers described themes that are aimed at encouraging lifestyle changes to promote healthy weight gain in pregnancy and can directly inform the development of a behavioral weight management intervention for pregnant and postpartum women that is patient-centered and tailored to their needs.
Collapse
Affiliation(s)
- Manasa S. Ayyala
- Rutgers New Jersey Medical School, Department of Medicine, Division of General Internal Medicine, 185 South Orange Avenue, MSB B624, Newark, NJ 07103 USA
| | - Janelle W. Coughlin
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Suite 1100, Baltimore, MD 21224 USA
| | - Lindsay Martin
- Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, 2024 E. Monument St, Suite 2-616, Baltimore, MD 21205 USA
| | - Janice Henderson
- Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, 600 N. Wolfe St, Nelson Building, Baltimore, MD 21287 USA
| | - Nneamaka Ezekwe
- School of Medicine, University of Mississippi Medical Center, Jackson, MS 39216 USA
| | - Jeanne M. Clark
- Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, 2024 E. Monument St, Suite 2-616, Baltimore, MD 21205 USA
| | - Lawrence J. Appel
- Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, 2024 E. Monument St, Suite 2-616, Baltimore, MD 21205 USA
| | - Wendy L. Bennett
- Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, 2024 E. Monument St, Suite 2-616, Baltimore, MD 21205 USA
| |
Collapse
|
13
|
Unick JL, Pellegrini CA, Dunsiger SI, Demos KE, Thomas JG, Bond DS, Webster J, Wing RR. DIAL now protocol: A randomized trial examining the provision of phone coaching to those with sub-optimal early weight loss during an Internet weight management program. Contemp Clin Trials 2020; 90:105953. [PMID: 32017994 PMCID: PMC7071958 DOI: 10.1016/j.cct.2020.105953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/22/2020] [Accepted: 01/30/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND While low-intensity Internet-delivered weight loss (IDWL) programs are efficacious, many patients fail to achieve clinically significant weight loss (WL). Given the positive association between 4-week and post-treatment WL, providing a more intensive intervention for those with sub-optimal 4-week WL may improve outcomes for a greater proportion of individuals. This stepped-care approach would minimize cost by reserving more aggressive treatment for those with sub-optimal early WL. OBJECTIVE This randomized trial examines whether the provision of brief or extended phone coaching for those with sub-optimal early WL improves 4- and 12-month WL when compared to no coaching. Secondary aims include examination of cost/kg WL and intervention engagement. METHODS 450 individuals (age 18-70 years, BMI: 25-45 kg/m2) will be randomized to: 1) IDWL+3 weeks of coaching ('Brief'), 2) IDWL+12 weeks of coaching ('Extended'), or 3) IDWL only ('Control'). All individuals will receive a 4-month IDWL program followed by an 8-month IDWL maintenance program. At week 4, individuals will be classified as early sub-optimal responders (<4% WL) or initial responders (≥4% WL). Individuals with sub-optimal early WL randomized to 'Brief' or 'Extended' will receive 3 and 12 weeks of phone coaching respectively, starting at week 5. Those with sub-optimal early WL randomized to 'Control', and initial responders will not receive any coaching. Assessments will occur at 4 and 12 months. DISCUSSION Study findings can inform the development of more effective IDWL programs. This model which provides additional support to those with sub-optimal early WL can easily be translated into healthcare and community settings.
Collapse
Affiliation(s)
- Jessica L Unick
- Warren Alpert Medical School at Brown University and The Miriam Hospital's Weight Control and Diabetes Research Center, Providence, RI, USA.
| | - Christine A Pellegrini
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Shira I Dunsiger
- Department of Behavioral and Social Sciences, Brown University School of Public Health, USA
| | - Kathryn E Demos
- Warren Alpert Medical School at Brown University and The Miriam Hospital's Weight Control and Diabetes Research Center, Providence, RI, USA
| | - J Graham Thomas
- Warren Alpert Medical School at Brown University and The Miriam Hospital's Weight Control and Diabetes Research Center, Providence, RI, USA
| | - Dale S Bond
- Warren Alpert Medical School at Brown University and The Miriam Hospital's Weight Control and Diabetes Research Center, Providence, RI, USA
| | - Jennifer Webster
- Warren Alpert Medical School at Brown University and The Miriam Hospital's Weight Control and Diabetes Research Center, Providence, RI, USA
| | - Rena R Wing
- Warren Alpert Medical School at Brown University and The Miriam Hospital's Weight Control and Diabetes Research Center, Providence, RI, USA
| |
Collapse
|
14
|
A Randomized Study of Values Affirmation to Promote Interest in Diabetes Prevention Among Women With a History of Gestational Diabetes. Med Care 2019; 57:528-535. [PMID: 31107396 DOI: 10.1097/mlr.0000000000001133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to test whether 2 interventions promote interest in diabetes prevention among women with a history of gestational diabetes mellitus, who face high lifetime risk for diabetes. RESEARCH DESIGN AND METHODS We designed an email outreach message promoting an existing preventive lifestyle program. The message incorporated values affirmation, a theory-based intervention that can improve openness to health information but typically relies on a writing exercise less practical in health care settings. In a 3-arm randomized study, 237 women with elevated body mass index and a history of gestational diabetes mellitus were randomized to read an outreach message containing either no affirmation (control) or 1 of 2 affirmations, streamlined to remove the typical writing exercise: either a values affirmation prompting reflection on any personal value, or a parenting affirmation prompting reflection on caregiving-related values. Outcomes included demonstrating interest in the lifestyle program (seeking information about it or intending to join) and seeking publicly-available health information about diabetes prevention. RESULTS Compared with control, participants randomized to the values affirmation more frequently demonstrated interest in the lifestyle program (59.0% vs. 74.4%; adjusted relative risk: 1.31; 95% confidence interval: 1.04-1.66) and sought information about diabetes prevention (59.0% vs. 73.4%; adjusted relative risk: 1.22; 95% confidence interval: 0.97-1.54). The parenting affirmation yielded no significant differences in either outcome. CONCLUSIONS A streamlined values affirmation, designed for feasibility in a health care setting, can promote interest in diabetes prevention among women at high risk. Research is needed to evaluate its effects on diabetes prevention program enrollment and clinical outcomes.
Collapse
|
15
|
Preventing Diabetes in High-Risk Patients: Time for a System-Level Approach to Disease Prevention. J Gen Intern Med 2019; 34:1367-1368. [PMID: 31098978 PMCID: PMC6667533 DOI: 10.1007/s11606-019-04994-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
16
|
Manocchia M, Donatell RC, Brown R, Bruce LD. Peer Benchmarking and Norm-Based Scoring to Improve Telephonic Health Coaching Quality. Jt Comm J Qual Patient Saf 2019; 45:613-619. [PMID: 31307916 DOI: 10.1016/j.jcjq.2019.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Studies evaluating telephonic coaching to improve population health have focused on outcomes, but measurement of consistency of coaching quality is also needed. The aim of this study was to describe how one multistate health plan developed, scored, and implemented a Coach Case Quality Assessment (CCQA) for quality improvement. METHODS The nine-item CCQA is a checklist of elements selected by quality improvement teams for peer benchmarking to improve telephonic coaching. The health plan fielded the CCQA to 470 clinical coaches in 2016. Quality reviewers rated coaches' call quality on each item (1 = learning; 2 = progressing; 3 = succeeding) and planned training around composite scores in relation to team norms. RESULTS A total of 470 coaches completed CCQAs with a norm-based mean score of 50.0 (standard deviation [SD] ± 10.0); 54.0% of coaches had scores within ±1 SD of the mean ("norm"), with 20.9% of coaches scoring below that range, and 25.1% scoring above it. Ninety-six percent (451/470) of coaches completed a nine-month follow-up. The mean norm-based score improved to 56.2 (SD ± 9.3), with 8.2% performing below, 42.4% at, and 49.4% above the peer norm. Scores represent significant mean and proportional changes over time, reflecting improvement on the part of whole teams. CONCLUSION This study demonstrates norm-based scoring as an effective strategy for measuring and improving coaching quality in a telephonic behavioral change program. Health plans can implement case quality review with norm-based scoring and peer benchmarking to aid coaches in continuous quality improvement.
Collapse
|
17
|
Mazza D, McCarthy E, Carey M, Turner L, Harris M. "90% of the time, it's not just weight": General practitioner and practice staff perspectives regarding the barriers and enablers to obesity guideline implementation. Obes Res Clin Pract 2019; 13:398-403. [PMID: 31109793 DOI: 10.1016/j.orcp.2019.04.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/25/2019] [Accepted: 04/05/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify the views of GPs and general practice staff regarding barriers and enablers to implementation of obesity guideline recommendations in general practice. METHODS Twenty general practitioners (GPs) and 18 practice staff from inner-eastern Melbourne, Australia, participated in semi-structured telephone interviews. The interview schedule was informed by the Theoretical Domains Framework (TDF). Interviews were audio-recorded, transcribed verbatim and underwent thematic analysis. RESULTS Participants lacked familiarity with and knowledge of the NHMRC obesity guidelines. Barriers and enablers were predominantly related to five theoretical domains: (1) environmental context and resources, (2) knowledge, (3) emotion, (4) beliefs about consequences, and (5) motivation and goals. Time pressures in consultations, costs for the patient, reluctance to add to patient burden particularly in those with comorbidities such as mental health issues, lack of awareness about services to refer patients to and GPs' fear of embarrassing patients and losing them were significant barriers. Enablers included having a strong doctor-patient relationship and a sense of responsibility to the patient to address weight. CONCLUSIONS Obesity guidelines and policy makers need to better engage with issues of multimorbidity, socioeconomic disadvantage and workforce issues if recommendations are to be widely adopted in general practice. Tasksharing, teamwork and technology are potential solutions to some of the barriers. Patient perspectives and approaches to being able to overcome stigma and legitimise obesity management in primary care consultations could also assist.
Collapse
Affiliation(s)
- D Mazza
- Department of General Practice, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia.
| | - E McCarthy
- Department of General Practice, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - M Carey
- School of Medicine and Public Health, University of Newcastle, Australia
| | - L Turner
- Department of General Practice, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - M Harris
- School of Public Health and Community Medicine, University of New South Wales, Australia
| |
Collapse
|
18
|
Reid N, Bennett W, Coughlin J, Thrift J, Kachur S, Gudzune KA. Evaluating an insurer-based health coaching program: Impact of program engagement on healthcare utilization and weight loss. Prev Med Rep 2018; 12:343-348. [PMID: 30425918 PMCID: PMC6226575 DOI: 10.1016/j.pmedr.2018.10.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/11/2018] [Accepted: 10/25/2018] [Indexed: 01/08/2023] Open
Abstract
Insurers and employers are increasingly offering lifestyle and weight-loss coaching programs; however, few evaluations have examined their effectiveness. Our objectives were to determine whether level of program engagement was associated with differences in healthcare utilization and weight pre/post coaching. We conducted a retrospective evaluation of enrollees in an insurer-based telephonic health coaching program in Maryland (2013-2014). Our independent variables were program engagement benchmarks (≥3 and ≥6 sessions). Our dependent variables included change in outpatient and emergency department (ED) visits (more visits post program, fewer visits post, or no change pre-post) and associated costs (difference pre-post) using claims data. We calculated mean percent weight change from baseline. We used multivariate-adjusted linear and multinomial logistic regression, as appropriate, to examine the association between outcomes and engagement benchmarks. We included 225 enrollees with mean age 50.7 years, 81.3% women, and mean body mass index of 35.0 kg/m2. Most participants focused on weight management (75.6%) and improving general health (57.8%). Few individuals had outpatient or ED visits, and no significant changes in healthcare utilization were associated with program engagement. Among the weight management subgroup (n = 170), mean weight change was -2.1% (SD 5.1). Participants achieved significantly greater weight loss if they met the 6-session engagement benchmark (β -3.5%, p < 0.01). Weight management is a popular focus for health coaching participants, and these programs can achieve modest weight loss. Programs should consider designing and testing strategies that promote engagement, given that weight-loss success was improved if participants completed at least 6 coaching sessions.
Collapse
Affiliation(s)
- Natalie Reid
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, United States of America
| | - Wendy Bennett
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, United States of America
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, United States of America
| | - Janelle Coughlin
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, United States of America
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, United States of America
| | - Jennifer Thrift
- Health Promotion & Wellness Unit, Care Management Department, Johns Hopkins HealthCare, LLC, United States of America
| | - Sarah Kachur
- Population Health Research and Development, Johns Hopkins HealthCare, LLC, United States of America
| | - Kimberly A. Gudzune
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, United States of America
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, United States of America
| |
Collapse
|
19
|
Ali MK, Wharam F, Kenrik Duru O, Schmittdiel J, Ackermann RT, Albu J, Ross-Degnan D, Hunter CM, Mangione C, Gregg EW. Advancing Health Policy and Program Research in Diabetes: Findings from the Natural Experiments for Translation in Diabetes (NEXT-D) Network. Curr Diab Rep 2018; 18:146. [PMID: 30456479 PMCID: PMC6640642 DOI: 10.1007/s11892-018-1112-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW To advance our understanding of the impacts of policies and programs aimed at improving detection, engagement, prevention, and clinical diabetes management in the USA, we synthesized findings from a network of studies that used natural experiments to evaluate diabetes health policies and programs. FINDINGS Studies from the Natural EXperiments for Translation in Diabetes (NEXT-D) network used rigorous longitudinal quasi-experimental study designs (e.g., interrupted time series) and analytical methods (e.g., difference-in-differences) to augment causal inference. Investigators partnered with health system stakeholders to evaluate whether glucose testing rates changed from before-to-after clinic interventions (e.g., integrating electronic screening decision prompts in New York City) or employer programs (e.g., targeted messaging and waiving copayments for at-risk employees). Other studies examined participation and behavior change in low- (e.g., wellness coaching) or high-intensity lifestyle modification programs (e.g., diabetes prevention program-like interventions) offered by payers or employers. Lastly, studies assessed how employer health insurance benefits impacted healthcare utilization, adherence, and outcomes among people with diabetes. NEXT-D demonstrated that low-intensity interventions to facilitate glucose testing and enhance engagement in lifestyle modification were associated with small improvements in weight but large improvements in screening and testing when supported by electronic health record-based decision-support. Regarding high-intensity diabetes prevention program-like lifestyle programs offered by payers or employers, enrollment was modest and led to weight loss and marginally lower short-term health expenditures. Health plans that incentivize patient behaviors were associated with increases in medication adherence. Meanwhile, shifting patients to high-deductible health plans was associated with no change in medication use and preventive screenings, but patients with diabetes delayed accessing healthcare for acute complications (e.g., cellulitis). Findings were more pronounced among lower-income patients, who experienced increased rates and acuity of emergency department visits for diabetes complications and other high-severity conditions. Findings from NEXT-D studies provide informative data that can guide programs and policies to facilitate detection, prevention, and treatment of diabetes in practice.
Collapse
Affiliation(s)
- Mohammed K Ali
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Mailstop K10, 4770 Buford Highway, Atlanta, GA, 30341, USA.
- Hubert Department of Global Health, Emory University, 1518 Clifton Road NE, Ste 7041 CNR Building, Atlanta, GA, 30322, USA.
| | - Frank Wharam
- Harvard Pilgrim Health Care Institute, Department of Population Medicine, Harvard Medical School, 401 Park Drive, Suite 401 East, Boston, MA, 02215, USA
| | - O Kenrik Duru
- Division of General Internal Medicine, University of California Los Angeles, 911 Broxton Ave., Los Angeles, CA, 90024, USA
| | - Julie Schmittdiel
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Ronald T Ackermann
- Department of Medicine, General Medicine Division, Northwestern University, Rubloff Building 10th Floor 750 N Lake Shore, Chicago, IL, 60611, USA
| | - Jeanine Albu
- Division of Endocrinology, Diabetes and Bone Diseases, Icahn School of Medicine at Mount Sinai, 1111 Amsterdam Avenue Babcock Building - 10th Floor, New York, NY, 10025, USA
| | - Dennis Ross-Degnan
- Harvard Pilgrim Health Care Institute, Department of Population Medicine, Harvard Medical School, 401 Park Drive, Suite 401 East, Boston, MA, 02215, USA
| | - Christine M Hunter
- Office of Behavioral and Social Sciences Research, National Institutes of Health, 31 Center Drive, Bethesda, MD, 20892, USA
| | - Carol Mangione
- Division of General Internal Medicine, University of California Los Angeles, UCLA Med-GIM & HSR BOX 957394, 10940 Wilshire Blvd, Los Angeles, CA, 90095, USA
| | - Edward W Gregg
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Mailstop K10, 4770 Buford Highway, Atlanta, GA, 30341, USA
| |
Collapse
|
20
|
DeJesus RS, Clark MM, Finney Rutten LJ, Jacobson RM, Croghan IT, Wilson PM, Jacobson DJ, Link SM, Fan C, St Sauver JL. Impact of a 12-week wellness coaching on self-care behaviors among primary care adult patients with prediabetes. Prev Med Rep 2018; 10:100-105. [PMID: 29850394 PMCID: PMC5966585 DOI: 10.1016/j.pmedr.2018.02.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 01/13/2018] [Accepted: 02/18/2018] [Indexed: 12/25/2022] Open
Abstract
This single arm prospective study assessed the impact of individualized wellness coaching intervention for primary care patients with prediabetes on self-reported changes in physical activity level and food choices. Five hundred sixty adult patients 18 years and older with prediabetes, seen in primary care clinic, were invited to participate in 12 weeks wellness coaching sessions delivered by certified coaches. Responses from questionnaires at baseline, 6 and 12 weeks were analyzed. Of 168 consented patients, 99 completed at least one coaching session; majority was elderly, female, overweight or obese. At baseline, 50% had <60 min aerobic exercise/week. At 6 and 12 weeks, average aerobic exercise time significantly increased from 117 min to 166 and 199 min respectively. Effect was sustained at 24 weeks. Success in making healthy eating choices also statistically improved from baseline. Significant effects on both activity level and eating behavior persisted even after adjusting for age, sex and baseline glucose/A1c values. Secondary outcomes of self-efficacy and quality of life likewise showed significant improvement. Results suggest that integration of wellness coaching in primary care practice among individuals at high risk for diabetes is feasible and may be useful as part of diabetes prevention management strategies in target populations. Future randomized clinical trials are needed to further explore this issue. Wellness coaching alone as an effective preventive strategy in patients with prediabetes is proposed. It can be incorporated in primary care practice. A 12 weeks session resulted in improved physical activity and healthy eating behavior. Self-efficacy and quality of life were also increased with coaching. Significant changes were seen in 6 weeks with sustained effect up to 24 weeks.
Collapse
Affiliation(s)
- Ramona S DeJesus
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.,Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - Matthew M Clark
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Lila J Finney Rutten
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.,Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Robert M Jacobson
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.,Division of Community Pediatrics and Adolescent Medicine, Department of Pediatrics and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Ivana T Croghan
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States.,Nicotine Research Program, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Patrick M Wilson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Debra J Jacobson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Sara M Link
- Dan Abrahams Healthy Living Center, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Chun Fan
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Jennifer L St Sauver
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.,Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| |
Collapse
|
21
|
Duru OK, Mangione CM, Rodriguez HP, Ross-Degnan D, Wharam JF, Black B, Kho A, Huguet N, Angier H, Mayer V, Siscovick D, Kraschnewski JL, Shi L, Nauman E, Gregg EW, Ali MK, Thornton P, Clauser S. Introductory Overview of the Natural Experiments for Translation in Diabetes 2.0 (NEXT-D2) Network: Examining the Impact of US Health Policies and Practices to Prevent Diabetes and Its Complications. Curr Diab Rep 2018; 18:8. [PMID: 29399715 PMCID: PMC8910460 DOI: 10.1007/s11892-018-0977-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW Diabetes incidence is rising among vulnerable population subgroups including minorities and individuals with limited education. Many diabetes-related programs and public policies are unevaluated while others are analyzed with research designs highly susceptible to bias which can result in flawed conclusions. The Natural Experiments for Translation in Diabetes 2.0 (NEXT-D2) Network includes eight research centers and three funding agencies using rigorous methods to evaluate natural experiments in health policy and program delivery. RECENT FINDINGS NEXT-D2 research studies use quasi-experimental methods to assess three major areas as they relate to diabetes: health insurance expansion; healthcare financing and payment models; and innovations in care coordination. The studies will report on preventive processes, achievement of diabetes care goals, and incidence of complications. Some studies assess healthcare utilization while others focus on patient-reported outcomes. NEXT-D2 examines the effect of public and private policies on diabetes care and prevention at a critical time, given ongoing and rapid shifts in the US health policy landscape.
Collapse
Affiliation(s)
- O Kenrik Duru
- Division of General Internal Medicine & Health Services Research, David Geffen School of Medicine, UCLA, 10940 Wilshire Blvd., Suite 700, Los Angeles, CA, 90024, USA.
| | - Carol M Mangione
- David Geffen School of Medicine at UCLA and Fielding School of Public Health, UCLA, Los Angeles, CA, USA
| | - Hector P Rodriguez
- School of Public Health - Health Policy and Management, University of California, Berkeley, Berkeley, CA, USA
| | - Dennis Ross-Degnan
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - J Frank Wharam
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Bernard Black
- Pritzker School of Law, Institute for Policy Research, and Kellogg School of Management, Northwestern University, Evanston, IL, USA
| | - Abel Kho
- Institute of Public Health & Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Victoria Mayer
- Department of Population Health Science and Policy, Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Jennifer L Kraschnewski
- Department of Medicine, Pediatrics and Public Health Sciences, Pennsylvania State University College of Medicine at Hershey Medical Center, Hershey, PA, USA
| | - Lizheng Shi
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | | | - Edward W Gregg
- Centers for Disease Control and Prevention, Division of Diabetes Translation, Atlanta, GA, USA
| | - Mohammed K Ali
- Centers for Disease Control and Prevention, Division of Diabetes Translation, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Pamela Thornton
- Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Disease, Bethesda, MD, USA
| | - Steven Clauser
- Health Care Delivery and Disparities Research Program, Patient-Centered Outcomes Research Institute, Washington, DC, USA
| |
Collapse
|