Integrating Online Weight Management with Primary Care Support: The - - PowerPoint PPT Presentation

Integrating Online Weight Management with Primary Care Support: The PROPS Study

Heather J. Baer, ScD

Associate Epidemiologist, Brigham and Women’s Hospital Assistant Professor, Harvard Medical School and Harvard T.H. Chan School of Public Health @ProfHeatherBaer September 20, 2019

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Heather J. Baer

• Nothing to disclose

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Background

• More than two-thirds of U.S. adults have overweight or obesity
• Associated with adverse health outcomes
• Small amounts of weight loss (3-5%) lead to significant health benefits
• Primary care providers (PCPs) often do not have sufficient time or

training to counsel patients about weight

• Need for scalable, low-cost weight management strategies

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Online Weight Loss Programs

• Online programs can help people achieve and maintain clinically

meaningful weight loss

• Magnitude of weight loss may be less than in face-to-face programs
• More convenient and less expensive; potential for broader reach
• Unclear whether online programs are effective and scalable in

routine primary care

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Population Health Management

• Innovative, team-based approach being implemented in many

primary care settings

• Non-clinical staff identify and reach out to groups of patients with

unmet preventive and chronic care needs

• Outside of face-to-face visits
• Improved outcomes for hypertension, diabetes, vaccination, and

colorectal cancer screening

• Not previously utilized for overweight or obesity

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Aims

• 1. To adapt an online weight management program and integrate

it with population health management support from primary care practices

• 2. To compare the effectiveness of 3 strategies:
• Usual care
• Online program alone
• Online program plus population health management support

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Study Design

• Pragmatic, cluster-randomized trial at Brigham and Women’s

Hospital (BWH) in Boston, MA

• 24 clinics within 15 primary care practices
• 8 clinics randomized to each arm
• Target sample size = 840 patients (280 per arm)

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Eligible Participants

• Recent visit at BWH primary care practice
• Age 20-70
• Body mass index (BMI) 27 - < 40 kg/m2
• Diagnosis of type 2 diabetes or hypertension
• English- or Spanish-speaking
• Internet access
• Motivated to lose weight

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Study Arms

Usual Care (UC)

• General written

information about weight management

Online Program Alone (OP)

• Access to online

program

• 12 months

Combined Intervention (CI)

• Access to online

program

• 12 months
• Weight-related

population health management support

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Online Program

• Adapted existing online program called BMIQ
• Cloud-based, HIPAA-compliant platform
• Collaborated with BMIQ team to enhance program
• Input from co-investigators, providers, and patient advisors
• Focus groups with patients and interviews with providers

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Enhancements to BMIQ

• 13 new educational sessions (for total of 33 sessions)
• Exchange-based meal plans
• Integration with Lose It!
• Mobile-responsive version
• Spanish version

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OP Arm (Online Program Alone)

• Access to BMIQ and instructions about how to use it
• Brief introduction by phone and follow-up one week later
• Optional phone consultation with registered dietitian

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CI Arm (Combined Intervention)

• Same access and instructions as OP arm
• Additional monitoring and outreach from Population Health

Manager (PHM), non-clinical staff member who works with PCPs

• Monthly check-in about progress
• Assess whether patients were logging in, viewing educational sessions,

and tracking weight, diet, and physical activity

• Update PCPs on patients’ progress
• Schedule second phone consultation with dietitian (optional)

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Outcomes

Primary

• utcome
• Weight change at 12 months

Secondary

• utcomes
• Weight change at 6 and 18 months
• Percent weight change
• Weight loss ≥ 5%
• Changes in blood pressure, cholesterol,

trigyclerides, hemoglobin A1c (HbA1c)

• Changes in weight-related quality of life,

health status, diet, physical activity

• Usage and satisfaction with interventions

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Data Collection

• Patients attended routine visits during 18-month follow-up

period (no required study visits)

• Data on weight and demographic and clinical factors from

electronic health record (EHR)

• Data on patient-reported outcomes from surveys
• Data on intervention usage from BMIQ
• Qualitative data from semi-structured interviews

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Participant Characteristics

• Enrolled 840 patients (326 UC, 216 OP, 298 CI)
• Mean age = 59.3 years
• Mean weight = 203.1 pounds, mean BMI = 32.5 kg/m2
• 60% female, 76% white, 97% English as primary language
• 96.4% hypertension, 24.4% type 2 diabetes

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Weight Change at 12 Months

• 3.0
• 4.1
• 7.1
• 8.0
• 7.0
• 6.0
• 5.0
• 4.0
• 3.0
• 2.0
• 1.0

0.0 UC OP CI

Weight change (pounds) p = 0.0002

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Percent Weight Change at 12 Months

• 1.6
• 1.9
• 3.1
• 3.5
• 3.0
• 2.5
• 2.0
• 1.5
• 1.0
• 0.5

0.0 UC OP CI

Weight change (percent) p = 0.002

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≥ 5% Weight Loss at 12 Months

16.0 21.1 32.9 0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 UC OP CI

Percent with ≥ 5% weight loss p < 0.0001

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Change in Confidence in Ability to Lose Weight at 12 Months

• 0.7
• 0.4

0.5

• 0.8
• 0.6
• 0.4
• 0.2

0.0 0.2 0.4 0.6 UC OP CI

Change in confidence (1-10) p = 0.0001

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Intervention Usage over 12 Months

25 5 22 6.5 3 26 5 21.5 7 9 5 10 15 20 25 30 Logins Sessions viewed Days with weight tracking data Days with food/activity tracking data Contacts with staff OP CI

Median number

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Patient Satisfaction at 12 Months

50.4 77.3 60.7 84.4 59.2 47.3 10 20 30 40 50 60 70 80 90 Satisfied/very satisfied with

• nline program

Definitely/probably would recommend online program Satisfied/very satisfied with PCP support for online program Satisfied/very satisfied with phone support/outreach for

• nline program

OP CI

Percent

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Patient Interviews

• Semi-structured interviews with 22 patients in OP and CI arms
• Most liked online program and found easy to use
• Several found it overwhelming, too time-consuming
• Patients in OP arm wanted more accountability
• Patients in CI arm liked additional support, but some would have

liked more frequent and specific

I like the concept of it. It was maybe a little too infrequent and maybe also a little too general for me to really equate it with a high level of value.

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Provider Interviews

• Semi-structured interviews with 9 providers in OP and CI arms
• All felt that the study helped them provide better care for their

patients and was useful resource

• Most felt that support and outreach in addition to online

program was helpful

I thought it was very helpful for the patients because they were not just going online to understand, they had a warm hand holding their hands from far away.

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Conclusions

• Significant difference in weight change at 12 months by arm
• Greatest weight loss in CI arm, then OP arm, then UC arm
• Strong evidence for online program plus population health

management in primary care to help patients with weight loss

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Future Directions

• Implement on larger scale?
• Examine effectiveness in broader population and in combination

with other interventions

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Acknowledgements

• David Bates
• Jason Block
• Renee Blocker
• Ihorma Breneus
• Barbara De La Cruz
• Julie Fiskio
• Florencia Halperin
• Kathy McManus
• Mary Merriam
• Nyryan Nolido
• Alison Olson
• John Orav
• Mary Reynolds
• Ronen Rozenblum
• Matt Wien
• All patients, PHMs, and PCPs

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Funding

• This work was (partially) supported through a Patient-Centered

Outcomes Research Institute (PCORI) Award (IHS-1409-21758).

• All statements in this report, including its findings and

conclusions, are solely those of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors or Methodology Committee.

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Learn More

• www.pcori.org
• info@pcori.org
• #PCORI2019
• @ProfHeatherBaer
• hbaer@bwh.harvard.edu