Protocol for the Rural Engagement in Primary Care for Optimizing Weight Reduction (RE-POWER) Trial: Comparing three obesity treatment models in rural primary care

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• 作者：Christie A. Befort^a ; ^{cbefort@kumc.edu" class="auth_mail" title="E-mail the corresponding author} ; Jeffrey J. VanWormer^b ; ^{vanwormer.jeffrey@mcrf.mfldclin.edu" class="auth_mail" title="E-mail the corresponding author} ; Cyrus DeSouza^c ; ^{cdesouza@unmc.edu" class="auth_mail" title="E-mail the corresponding author} ; Edward F. Ellerbeck^a ; ^{eellerbe@kumc.edu" class="auth_mail" title="E-mail the corresponding author} ; Kim S. Kimminau^d ; ^{kkimmina@kumc.edu" class="auth_mail" title="E-mail the corresponding author} ; Allen Greiner^d ; ^{agreiner@kumc.edu" class="auth_mail" title="E-mail the corresponding author} ; Byron Gajewski^e ; ^{bgajewski@kumc.edu" class="auth_mail" title="E-mail the corresponding author} ; Terry Huang^f ; ^{terry.huang@sph.cuny.edu" class="auth_mail" title="E-mail the corresponding author} ; Michael G. Perri^g ; ^{mperri@phhp.ufl.edu" class="auth_mail" title="E-mail the corresponding author} ; Tera L. Fazzino^a ; Danielle Christifano^a ; ^{dchristifano@kumc.edu" class="auth_mail" title="E-mail the corresponding author} ; Leslie Eiland^c ; ^{leslie.eiland@unmc.edu" class="auth_mail" title="E-mail the corresponding author} ; Andjela Drincic^c ; ^{andjela.drincic@unmc.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：FFS ; fee-for-service ; PCMH ; patient-centered medical home ; DM ; disease management ; PCP ; primary care provider ; CMS ; Centers for Medicare and Medicaid Services ; FQHC ; federally qualified health center ; PAB ; Patient Advisory Board ; RE-AIM ; Reach ; Adoption ; Implementation ; Maintenance ; RHC ; Rural Health Clinic ; CFIR ; Consolidated Framework for Implementation Research
• 刊名：Contemporary Clinical Trials
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：47
• 期：Complete
• 页码：304-314
• 全文大小：788 K

文摘

Obesity disproportionately affects rural residents in the United States, and primary care has the potential to fill a major gap in the provision of weight management services for rural communities. The objective of this cluster-randomized pragmatic trial is to evaluate the comparative effectiveness of three obesity treatment models in rural primary care: the Intensive Behavior Therapy fee-for-service (FFS) model reimbursed by Medicare, a team-based model that recognizes the patient-centered medical home (PCMH) as a preferred delivery approach, and the centralized disease management (DM) model, in which phone-based counseling is provided outside of the primary care practice. We hypothesize that the PCMH and DM treatments will be more effective than FFS in reducing weight at 24 months. Thirty-six practices from the rural Midwestern U.S. are randomized to deliver one of the three interventions to 40 patients (N = 1440) age 20 to 75 with a BMI 30–45 kg/m². In the FFS arm, primary care providers and their personnel counsel patients to follow evidence-based weight loss guidelines using the Medicare-designated treatment schedule. In the PCMH arm, patients receive a comprehensive weight management intervention delivered locally by practice personnel using a combination of in-person and phone-based group sessions. In the DM arm, the same intervention is delivered remotely by obesity treatment specialists via group conference calls. The primary outcome is weight loss at 24 months. Additional measures include fasting glucose, lipids, quality of life indicators, and implementation process measures. Findings will illuminate effective obesity treatment intervention(s) in rural primary care.