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 3

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 4

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 5

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 6

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 7

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) 8

Eligible Participants • Recent visit at BWH primary care practice • Age 20-70 • Body mass index (BMI) 27 - < 40 kg/m 2 • Diagnosis of type 2 diabetes or hypertension • English- or Spanish-speaking • Internet access • Motivated to lose weight 9

Study Arms Online Program Combined Usual Care (UC) Alone (OP) Intervention (CI) • General written • Access to online • Access to online information program program about weight • 12 months • 12 months management • Weight-related population health management support 10

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 11

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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 13

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 14

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) 15

Outcomes Primary • Weight change at 12 months outcome • Weight change at 6 and 18 months • Percent weight change • Weight loss ≥ 5% Secondary • Changes in blood pressure, cholesterol, outcomes trigyclerides, hemoglobin A1c (HbA1c) • Changes in weight-related quality of life, health status, diet, physical activity • Usage and satisfaction with interventions 16

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 17

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/m 2 • 60% female, 76% white, 97% English as primary language • 96.4% hypertension, 24.4% type 2 diabetes 18

Weight Change at 12 Months 0.0 -1.0 Weight change (pounds ) -2.0 UC OP CI -3.0 p = 0.0002 -3.0 -4.0 -4.1 -5.0 -6.0 -7.0 -7.1 -8.0 19

Percent Weight Change at 12 Months 0.0 -0.5 Weight change (percent ) UC OP CI -1.0 p = 0.002 -1.5 -1.6 -2.0 -1.9 -2.5 -3.0 -3.1 -3.5 20

≥ 5% Weight Loss at 12 Months 35.0 32.9 30.0 Percent with ≥ 5% weight loss UC OP CI 25.0 21.1 p < 0.0001 20.0 16.0 15.0 10.0 5.0 0.0 21

Change in Confidence in Ability to Lose Weight at 12 Months 0.6 0.5 0.4 Change in confidence (1-10 ) UC OP CI 0.2 p = 0.0001 0.0 -0.2 -0.4 -0.4 -0.6 -0.7 -0.8 22

Intervention Usage over 12 Months 30 26 25 25 22 21.5 OP CI Median number 20 15 9 10 7 6.5 5 5 5 3 0 Logins Sessions viewed Days with weight Days with food/activity Contacts with staff tracking data tracking data 23

Patient Satisfaction at 12 Months 90 84.4 77.3 80 OP CI 70 60.7 59.2 60 Percent 50.4 47.3 50 40 30 20 10 0 Satisfied/very satisfied with Definitely/probably would Satisfied/very satisfied with Satisfied/very satisfied with online program recommend online program PCP support for online phone support/outreach for program online program 24

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. 25

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. 26

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 27

Future Directions • Implement on larger scale? • Examine effectiveness in broader population and in combination with other interventions 28

Acknowledgements • Mary Merriam • David Bates • Jason Block • Nyryan Nolido • Renee Blocker • Alison Olson • John Orav • Ihorma Breneus • Mary Reynolds • Barbara De La Cruz • Julie Fiskio • Ronen Rozenblum • Florencia Halperin • Matt Wien • All patients, PHMs, and PCPs • Kathy McManus 29

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. 30

Learn More • www.pcori.org • info@pcori.org • #PCORI2019 • @ProfHeatherBaer • hbaer@bwh.harvard.edu 31