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Suresh K, Willems E, Williams J, Gritz RM, Dickinson LM, Perreault L, Holtrop JS. An Assessment of Weight Loss Management in Health System Primary Care Practices. J Am Board Fam Med 2023; 36:51-65. [PMID: 36460354 PMCID: PMC10482321 DOI: 10.3122/jabfm.2022.220224r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/12/2022] [Accepted: 08/17/2022] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Primary care practices can help patients address obesity through weight loss; however, there are many barriers to doing so. This study examined weight management services provided and factors associated with higher reported provision of services. METHODS A survey was given to practice members in 18 primary care practices in a Colorado-based health system. The survey assessed weight management services to determine the amount and type of weight loss assistance provided and other factors that may be important. We used descriptive statistics to summarize responses and linear regression with generalized estimating equations to assess the association between the practice and practice member characteristics and the amount of weight management services provided. RESULTS The overall response rate was 64% (254/399). On average, clinicians reported performing 73% of the services, and when grouped into minimal, basic, and extensive, the clinicians on average performed 87%, 68%, and 69% of them, respectively. In a multivariable model adjusted for demographics, factors associated with performing more services included perception of overall better practice culture and perception of weight management implementation climate. CONCLUSIONS Practice-associated factors such as culture and implementation climate may be worth examining to understand how to implement weight management in primary care.
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Affiliation(s)
- Krithika Suresh
- From Colorado School of Public Health Department of Biostatistics & Informatics, Aurora (KS, EW); University of Colorado Department of Family Medicine, Aurora (JW, LMD, JSH); University of Colorado Department Medicine-Division of Health Care Policy Research, Aurora (RMG); University of Colorado Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), Aurora (RMG, JSH); University of Colorado Department Medicine-Endocrinology/Metabolism/Diabetes, Aurora (LP)
| | - Emileigh Willems
- From Colorado School of Public Health Department of Biostatistics & Informatics, Aurora (KS, EW); University of Colorado Department of Family Medicine, Aurora (JW, LMD, JSH); University of Colorado Department Medicine-Division of Health Care Policy Research, Aurora (RMG); University of Colorado Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), Aurora (RMG, JSH); University of Colorado Department Medicine-Endocrinology/Metabolism/Diabetes, Aurora (LP)
| | - Johnny Williams
- From Colorado School of Public Health Department of Biostatistics & Informatics, Aurora (KS, EW); University of Colorado Department of Family Medicine, Aurora (JW, LMD, JSH); University of Colorado Department Medicine-Division of Health Care Policy Research, Aurora (RMG); University of Colorado Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), Aurora (RMG, JSH); University of Colorado Department Medicine-Endocrinology/Metabolism/Diabetes, Aurora (LP)
| | - R Mark Gritz
- From Colorado School of Public Health Department of Biostatistics & Informatics, Aurora (KS, EW); University of Colorado Department of Family Medicine, Aurora (JW, LMD, JSH); University of Colorado Department Medicine-Division of Health Care Policy Research, Aurora (RMG); University of Colorado Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), Aurora (RMG, JSH); University of Colorado Department Medicine-Endocrinology/Metabolism/Diabetes, Aurora (LP)
| | - L Miriam Dickinson
- From Colorado School of Public Health Department of Biostatistics & Informatics, Aurora (KS, EW); University of Colorado Department of Family Medicine, Aurora (JW, LMD, JSH); University of Colorado Department Medicine-Division of Health Care Policy Research, Aurora (RMG); University of Colorado Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), Aurora (RMG, JSH); University of Colorado Department Medicine-Endocrinology/Metabolism/Diabetes, Aurora (LP)
| | - Leigh Perreault
- From Colorado School of Public Health Department of Biostatistics & Informatics, Aurora (KS, EW); University of Colorado Department of Family Medicine, Aurora (JW, LMD, JSH); University of Colorado Department Medicine-Division of Health Care Policy Research, Aurora (RMG); University of Colorado Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), Aurora (RMG, JSH); University of Colorado Department Medicine-Endocrinology/Metabolism/Diabetes, Aurora (LP)
| | - Jodi Summers Holtrop
- From Colorado School of Public Health Department of Biostatistics & Informatics, Aurora (KS, EW); University of Colorado Department of Family Medicine, Aurora (JW, LMD, JSH); University of Colorado Department Medicine-Division of Health Care Policy Research, Aurora (RMG); University of Colorado Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), Aurora (RMG, JSH); University of Colorado Department Medicine-Endocrinology/Metabolism/Diabetes, Aurora (LP)
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Agarwal SD, Basu S, Landon BE. The Underuse of Medicare's Prevention and Coordination Codes in Primary Care : A Cross-Sectional and Modeling Study. Ann Intern Med 2022; 175:1100-1108. [PMID: 35759760 PMCID: PMC9933078 DOI: 10.7326/m21-4770] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Efforts to better support primary care include the addition of primary care-focused billing codes to the Medicare Physician Fee Schedule (MPFS). OBJECTIVE To examine potential and actual use by primary care physicians (PCPs) of the prevention and coordination codes that have been added to the MPFS. DESIGN Cross-sectional and modeling study. SETTING Nationally representative claims and survey data. PARTICIPANTS Medicare patients. MEASUREMENTS Frequency of use and estimated Medicare revenue involving 34 billing codes representing prevention and coordination services for which PCPs could but do not necessarily bill. RESULTS Eligibility among Medicare patients for each service ranged from 8.8% to 100%. Among eligible patients, the median use of billing codes was 2.3%, even though PCPs provided code-appropriate services to more patients, for example, to 5.0% to 60.6% of patients eligible for prevention services. If a PCP provided and billed all prevention and coordination services to half of all eligible patients, the PCP could add to the practice's annual revenue $124 435 (interquartile range [IQR], $30 654 to $226 813) for prevention services and $86 082 (IQR, $18 011 to $154 152) for coordination services. LIMITATION Service provision based on survey questions may not reflect all billing requirements; revenues do not incorporate the compliance, billing, and opportunity costs that may be incurred when using these codes. CONCLUSION Primary care physicians forego considerable amounts of revenue because they infrequently use billing codes for prevention and coordination services despite having eligible patients and providing code-appropriate services to some of those patients. Therefore, creating additional billing codes for distinct activities in the MPFS may not be an effective strategy for supporting primary care. PRIMARY FUNDING SOURCE National Institute on Aging.
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Affiliation(s)
- Sumit D Agarwal
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts (S.D.A.)
| | | | - Bruce E Landon
- Department of Health Care Policy, Harvard Medical School, and Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts (B.E.L.)
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Kyle TK, Stanford FC. Moving Toward Health Policy that Respects Both Science and People Living with Obesity. Nurs Clin North Am 2021; 56:635-645. [PMID: 34749901 PMCID: PMC8592383 DOI: 10.1016/j.cnur.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Through four decades of rising obesity, health policy has been mostly ineffective. Prevention policies failed to reverse rising trends in prevalence, partly because they are often based on biased mental models about what should work to prevent obesity, rather than empiric evidence for what does work. Bias toward people living with obesity harms health, while contributing to poor access to effective care that might serve to improve it. Better public policy will come from an increased application of objective obesity science, research to fill knowledge gaps, and respect for the human dignity of people who live with obesity.
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Affiliation(s)
- Theodore K Kyle
- ConscienHealth, 2270 Country Club Drive, Pittsburgh, PA 15241, USA.
| | - Fatima Cody Stanford
- Department of Medicine, Division of Endocrinology-Neuroendocrine, Massachusetts General Hospital, MGH Weight Center, 50 Staniford Street, Boston, MA 02114, USA; Department of Pediatrics, Division of Endocrinology, Nutrition Obesity Research Center at Harvard (NORCH), 50 Staniford Street, Boston, MA 02114, USA
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Primary care clinicians' perspectives on clinical decision support to enhance outcomes of online obesity treatment in primary care: A qualitative formative evaluation. ACTA ACUST UNITED AC 2021; 6:515-526. [PMID: 34722861 DOI: 10.1007/s41347-021-00206-6] [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] [Indexed: 02/05/2023]
Abstract
Objective Online behavioral treatment for obesity produces clinically-meaningful weight losses among many primary care patients. However, some patients experience poor outcomes (i.e., failure to enroll post-referral, poor weight loss, or premature disengagement). This study sought to understand primary care clinicians' perceived utility of a clinical decision support system (CDSS) that would alert clinicians to patients' risk for poor outcome and guide clinician-delivered rescue interventions to reduce risk. Methods Qualitative formative evaluation was conducted in the context of an ongoing pragmatic clinical trial implementing online obesity treatment in primary care. Interviews were conducted with 14 nurse care managers (NCMs) overseeing patients' online obesity treatment. Interviews inquired about the potential utility of CDSS in primary care, desired alert frequency/format, and priorities for alert types (non-enrollment, poor weight loss, and/or early disengagement). We used matrix analysis to generate common themes across interviews. Results Nearly all NCMs viewed CDSS as potentially helpful in clinical practice. Alerts for patients at risk for disengagement were of highest priority, though all alert types were generally viewed as desirable. Regarding frequency and delivery mode of patient alerts, NCMs wanted to balance the need for prompt patient intervention with minimizing clinician burden. Concerns about CDSS emerged, including insufficient time to respond promptly and adequately to alerts and the need to involve other support staff for patients requiring ongoing rescue intervention. Conclusions NCMs view CDSS for online obesity treatment as potentially feasible and clinically useful. For optimal implementation in primary care, CDSS must minimize clinician burden and facilitate collaborative care.
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