National Healthcare Quality and Disparities Report
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- Alcohol Use (1)
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- Clinician-Patient Communication (1)
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- (-) Obesity (20)
- Obesity: Weight Management (7)
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- (-) Primary Care (20)
- Primary Care: Models of Care (1)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 20 of 20 Research Studies DisplayedHoltrop JS, Connelly L, Gomes R
Models for delivering weight management in primary care: qualitative results from the MOST obesity study.
The purpose of this study was to examine how clinical primary care practices successfully and feasibly implement weight management services. The researchers utilized multiple methods including site visits, observations, interviews, and document reviews to practices across the United States. Qualitative research was conducted to identify unique features that were feasible to implement in primary care. The study identified 4 delivery models across 21 practices: group delivery, delivery integrated into standard primary care, hiring an "other" professional for delivery, and delivery utilizing a specific program. Features of the model included who delivered the services, whether the services were delivered to an individual or a group, the methods the service utilized, and how the care was paid. The majority of practices combined weight management services and primary care delivery, but some developed specific programs.
AHRQ-funded; HS024943.
Citation: Holtrop JS, Connelly L, Gomes R .
Models for delivering weight management in primary care: qualitative results from the MOST obesity study.
J Am Board Fam Med 2023 Aug 9; 36(4):603-15. doi: 10.3122/jabfm.2022.220315R2..
Keywords: Obesity, Primary Care
Halliday TM, McFadden M, Cedillo M
Lifestyle strategies after intentional weight loss: results from the MAINTAIN-pc randomized trial.
The aim of this study was to explore the strategies related with successful long-term weight loss maintenance. Researchers analyzed data from the 24-month Maintaining Activity and Nutrition Through Technology-Assisted Innovation in Primary Care (MAINTAIN-pc) trial. MAINTAIN-pc recruited 194 adults with recent intentional weight loss and randomized participants a group using tracking tools plus coaching (i.e., coaching group) or tracking tools without coaching (i.e., tracking-only group). The participants reported the lifestyle strategies they utilized in the previous 6 months, including self-monitoring, group support, behavioral skills, and professional support. The study found that at baseline, 100% used behavioral skills, 73% used group support, 69% used self-monitoring, and 68% used professional support in the past 6 months; at 24 months, the rates were 98%, 60%, 75%, and 61%, respectively. The number of participants using individual strategies did not vary significantly over time, but the overall number of strategies participants reported decreased. A greater number of strategies were utilized at baseline and 6 months compared to 12- and 24-month follow-ups. The coaching group utilized a greater number of strategies at months 6 and 12 than the tracking-only group. Consistent utilization of professional support strategies over the 24-month study period was related with less weight regain.
AHRQ-funded; HS021162.
Citation: Halliday TM, McFadden M, Cedillo M .
Lifestyle strategies after intentional weight loss: results from the MAINTAIN-pc randomized trial.
Transl J Am Coll Sports Med 2023 Spring; 8(2). doi: 10.1249/tjx.0000000000000220..
Keywords: Lifestyle Changes, Obesity, Primary Care, Electronic Health Records (EHRs), Health Information Technology (HIT)
Barlow SE, Yudkin J, Nelson V
Dynamo Kids!/¡Niños Dinámicos! A web site for pediatric primary care providers to offer parents of children 6-12 years old with overweight and obesity: web site development and protocol for pilot study.
The purpose of this study will be to determine whether a self-guided web site offered by pediatric primary care providers could assist parents with applying healthy behaviors. If successful, a large, controlled study may be conducted to further assess. The Dynamo Kids/¡Niños Dinámicos program was created with feedback from parents and health care professionals, developing a bilingual site for parents to about healthy behavior changes for their children and how to implement them. Electronic health record modifications alert providers to qualified children at well-child encounters. Parents complete online surveys before entering the site. In month 3 of the study, the practitioners will examine children in weight-focused appointments. Outcomes include change in Family Nutrition and Physical Activity parent survey score (primary) and change in child relative BMI (secondary). Additional data include time spent on site, provider surveys, and provider and parent interviews.
AHRQ-funded; HS022418.
Citation: Barlow SE, Yudkin J, Nelson V .
Dynamo Kids!/¡Niños Dinámicos! A web site for pediatric primary care providers to offer parents of children 6-12 years old with overweight and obesity: web site development and protocol for pilot study.
J Pediatr Health Care 2023 Jan-Feb; 37(1):17-24. doi: 10.1016/j.pedhc.2022.09.003..
Keywords: Children/Adolescents, Primary Care, Obesity, Obesity: Weight Management, Education: Patient and Caregiver, Family Health and History
Luo Z, Gritz M, Connelly L
A survey of primary care practices on their use of the intensive behavioral therapy for obese Medicare patients.
The objective of this study was to fill the gap in knowledge on systematic differences between primary care practices (PCP) that do or do not provide intensive behavioral therapy (IBT) for obese Medicare patients. The investigators concluded that although the Centers for Medicare and Medicaid Services established payment codes for PCPs to deliver IBT for obesity in 2011, very few providers submitted fee-for-service claims for these services after almost 10 years.
AHRQ-funded; HS024843.
Citation: Luo Z, Gritz M, Connelly L .
A survey of primary care practices on their use of the intensive behavioral therapy for obese Medicare patients.
J Gen Intern Med 2021 Sep;36(9):2700-08. doi: 10.1007/s11606-021-06596-w..
Keywords: Primary Care, Obesity, Behavioral Health, Medicare, Elderly
Nederveld A, Phimphasone-Brady P, Connelly L
The joys and challenges of delivering obesity care: a qualitative study of US primary care practices.
The authors sought to explore the experience of providing obesity management among primary care clinicians and their team members involved with weight loss in primary care practices. They identified three primary themes: (1) clinicians and staff involved in obesity management in primary care believe that addressing obesity is an essential part of primary care services, (2) because providing obesity care can be challenging, many practices opt out of treatment, and (3) despite the challenges, many clinicians and others find treating obesity feasible, satisfying, and worthwhile. The authors concluded that, in order to improve the ability of clinicians and practice members to treat obesity, important changes in payment, education, and work processes are necessary.
AHRQ-funded; HS024943.
Citation: Nederveld A, Phimphasone-Brady P, Connelly L .
The joys and challenges of delivering obesity care: a qualitative study of US primary care practices.
J Gen Intern Med 2021 Sep;36(9):2709-16. doi: 10.1007/s11606-020-06548-w..
Keywords: Obesity, Obesity: Weight Management, Primary Care, Medicare
Rosas LG, Lv N, Xiao L
Effect of a culturally adapted behavioral intervention for Latino adults on weight loss over 2 years: a randomized clinical trial.
Identifying effective weight loss interventions for Latino adults at risk of diabetes is of critical public health importance. The purpose of this study was to determine whether a culturally adapted behavioral intervention for Latino adults was more effective than usual care for weight loss over 24 months. The investigators concluded that among Latino adults with high diabetes risk, a culturally adapted behavioral lifestyle intervention was effective for weight loss over 12 months but not 24 months.
AHRQ-funded; HS022702.
Citation: Rosas LG, Lv N, Xiao L .
Effect of a culturally adapted behavioral intervention for Latino adults on weight loss over 2 years: a randomized clinical trial.
JAMA Netw Open 2020 Dec;3(12):e2027744. doi: 10.1001/jamanetworkopen.2020.27744..
Keywords: Racial and Ethnic Minorities, Obesity: Weight Management, Obesity, Cultural Competence, Diabetes, Primary Care, Outcomes, Patient-Centered Outcomes Research, Comparative Effectiveness, Evidence-Based Practice
Kovalerchik O, Powers E, Holland ML
Differences in frequency of visits to pediatric primary care practices and emergency departments by body mass index.
The purpose of this retrospective study was to examine differences in utilization across health care settings among children by body mass index (BMI) categories to help identify opportunities for interventions. The authors concluded that the children's BMI categories were associated with health care utilization, specifically primary care visits, ED visits, and hospitalizations.
AHRQ-funded; HS024332.
Citation: Kovalerchik O, Powers E, Holland ML .
Differences in frequency of visits to pediatric primary care practices and emergency departments by body mass index.
Acad Pediatr 2020 May-Jun;20(4):532-39. doi: 10.1016/j.acap.2019.12.011..
Keywords: Children/Adolescents, Primary Care, Emergency Department, Obesity, Healthcare Utilization
Gibbs BB, Tudorascu D, Bryce CL
Lifestyle habits associated with weight regain after intentional loss in primary care patients participating in a randomized trial.
This study examined lifestyle habits associated with weight regain at 6 and 24 months after intentional loss in primary care patients. This randomized trial used adult primary care patients who had a recent weight loss of at least 5%. Lifestyle habits measured using the Connor Diet Habit Survey included consumption of low-fat foods, fish, desserts, sugary beverages, fruits and vegetables and eating at restaurants; moderate-vigorous physical activity by self-report; steps recorded on a pedometer; and sedentary behavior by self-report. Participants had a mean age of 53.4 years, were 26% male and 88% white. Overall, they maintained weight loss at 6 months, but began to regain weight at 24 months. The habits most attributed to weight regain included more eating at restaurants, less fish consumption, and less physical activity. More sedentary behavior was associated with weight regain at 6 months, and reduced consumption of low-fat foods and more desserts and sugary beverages were associated with weight regain at 24 months.
AHRQ-funded; HS021162.
Citation: Gibbs BB, Tudorascu D, Bryce CL .
Lifestyle habits associated with weight regain after intentional loss in primary care patients participating in a randomized trial.
J Gen Intern Med 2020 Nov;35(11):3227-33. doi: 10.1007/s11606-020-06056-x..
Keywords: Obesity: Weight Management, Obesity, Lifestyle Changes, Primary Care, Nutrition
Drouin O, Sharifi M, Gerber M
Parents' willingness to pay for pediatric weight management programs.
This study examined parents’ interested in continuing and willingness to pay (WTP) for 2 pediatric weight management programs after their childrens’ participation. Participants were parents of 2- to 12-year-old children with a body mass index equal to or greater than the 85th percentile who participated in the Connect for Health trial. One group received enhanced primary care (EPC) and the other group EPC plus individualized coaching (EPC+C). After 1 year, they assessed parents’ self-reported WTP for a similar program and the maximum amount they would pay. Of 638 parents polled, 85% were interested in continuing and 38% of them were willing to pay. The median amount they were willing to pay was $25/month. Parents of Hispanic/Latino children versus white ethnicity and those reporting a higher satisfaction with the program more most likely to endorse WTP. Parents of children getting EPC+C were also more willing to pay.
AHRQ-funded; HS024332; HS022986.
Citation: Drouin O, Sharifi M, Gerber M .
Parents' willingness to pay for pediatric weight management programs.
Acad Pediatr 2019 Sep - Oct;19(7):764-72. doi: 10.1016/j.acap.2019.05.124..
Keywords: Children/Adolescents, Obesity: Weight Management, Obesity, Healthcare Costs, Caregiving, Primary Care, Primary Care: Models of Care
Shafer PR, Borsky A, Ngo-Metzger Q
AHRQ Author: Shafer PR, Borsky A, Ngo-Metzger Q, Miller T, Meyers D
The practice gap: national estimates of screening and counseling for alcohol, tobacco, and obesity.
The authors of this study estimated screening and counseling rates for tobacco and alcohol use, and obesity by using a nationally representative sample of adults aged 35 years and older. Receipt of the recommended level of services ranged from nearly two-thirds for obesity and tobacco use to less than half for alcohol misuse. The authors conclude that care delivery shows significant room for improvement, but primary care practices may need additional resources to raise their screening and counseling rates.
AHRQ-authored.
Citation: Shafer PR, Borsky A, Ngo-Metzger Q .
The practice gap: national estimates of screening and counseling for alcohol, tobacco, and obesity.
Ann Fam Med 2019 Mar;17(2):161-63. doi: 10.1370/afm.2363..
Keywords: Alcohol Use, Lifestyle Changes, Obesity, Prevention, Primary Care, Screening, Substance Abuse, Tobacco Use
Grout RW, Thompson-Fleming R, Carroll AE
Prevalence of pain reports in pediatric primary care and association with demographics, body mass index, and exam findings: a cross-sectional study.
The objective of this study was to determine the rate of positive pain screenings in pediatric primary care and evaluate the relationship between reported pain and obesity, demographics, and exam findings during routine pediatric encounters. The investigators concluded that pain is common in general pediatric encounters, and occurs more frequently in obese children and those who previously reported pain. Pain reporting may be influenced by seasonal variation and clinic factors.
AHRQ-funded; HS020640; HS018453; HS017939.
Citation: Grout RW, Thompson-Fleming R, Carroll AE .
Prevalence of pain reports in pediatric primary care and association with demographics, body mass index, and exam findings: a cross-sectional study.
BMC Pediatr 2018 Nov 21;18(1):363. doi: 10.1186/s12887-018-1335-0..
Keywords: Children/Adolescents, Obesity, Pain, Children/Adolescents, Primary Care
Hanna RM, Fischer G, Conroy MB
Online lifestyle modification intervention: survey of primary care providers' attitudes and views.
The aim of this study was to evaluate the response of primary care providers (PCPs) to a referral model for implementing a year-long online intervention for weight loss to obese adult patients. The investigators suggest that understanding providers' views and barriers regarding the integration of online tools will facilitate widespread implementation of an online lifestyle modification intervention.
AHRQ-funded; HS018155.
Citation: Hanna RM, Fischer G, Conroy MB .
Online lifestyle modification intervention: survey of primary care providers' attitudes and views.
J Med Internet Res 2018 Jun 8;20(6):e167. doi: 10.2196/jmir.8616..
Keywords: Health Information Technology (HIT), Lifestyle Changes, Obesity, Primary Care, Provider
Halbert CH, Jefferson M, Melvin CL
Provider advice about weight loss in a primary care sample of obese and overweight patients.
In this study the investigators examined receipt of provider advice to lose weight among primary care patients who were overweight and obese. The investigators found that patient beliefs about their weight status and perceptions about shared decision-making are important to receiving provider advice about weight loss/management among primary care patients.
AHRQ-funded; HS023047.
Citation: Halbert CH, Jefferson M, Melvin CL .
Provider advice about weight loss in a primary care sample of obese and overweight patients.
J Prim Care Community Health 2017 Oct;8(4):239-46. doi: 10.1177/2150131917715336..
Keywords: Shared Decision Making, Obesity, Obesity: Weight Management, Practice Patterns, Primary Care
Bello JK, Mohanty N, Bauer V
Pediatric hypertension: provider perspectives.
The researchers aimed to gain insights into reasons for low rates of diagnosis and treatment from primary care providers. In interviews, providers reflected on numerous barriers to diagnosis, management, and follow-up; recommendations for educational content; and how community health center systems can be improved. Findings informed development of a multifaceted intervention.
AHRQ-funded; HS024100.
Citation: Bello JK, Mohanty N, Bauer V .
Pediatric hypertension: provider perspectives.
Glob Pediatr Health 2017 Jun 6;4:2333794x17712637. doi: 10.1177/2333794x17712637.
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Keywords: Children/Adolescents, Diagnostic Safety and Quality, Healthcare Delivery, Blood Pressure, Obesity, Primary Care
Turer CB, Barlow SE, Montano S
Discrepancies in communication versus documentation of weight-management benchmarks: analysis of recorded visits with Latino children and associated health-record documentation.
To examine gaps in communication versus documentation of weight-management clinical practices, communication was recorded during primary care visits with 6- to 12-year-old overweight/obese Latino children. The researchers found that benchmarks were neither communicated nor documented in up to 42 percent of visits, and communicated but not documented or documented but not communicated in up to 20 percent of visits.
AHRQ-funded; HS022418.
Citation: Turer CB, Barlow SE, Montano S .
Discrepancies in communication versus documentation of weight-management benchmarks: analysis of recorded visits with Latino children and associated health-record documentation.
Glob Pediatr Health 2017 Feb 6;4:2333794x16685190. doi: 10.1177/2333794x16685190.
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Keywords: Children/Adolescents, Communication, Obesity, Primary Care, Obesity: Weight Management
Batsis JA, Pletcher SN, Stahl JE
Telemedicine and primary care obesity management in rural areas - innovative approach for older adults?
The Centers for Medicare and Medicaid recognized the importance of treating obesity and instituted a benefit in primary care settings to encourage intensive behavioral therapy in beneficiaries by primary care clinicians. This benefit covers frequent, brief, clinic visits designed to address older adult obesity. This review outlines some of the challenges with the current benefit and proposed solutions in overcoming rural primary care barriers to implementation, including changes in staffing models.
AHRQ-funded; HS021681.
Citation: Batsis JA, Pletcher SN, Stahl JE .
Telemedicine and primary care obesity management in rural areas - innovative approach for older adults?
BMC Geriatr 2017 Jan 5;17(1):6. doi: 10.1186/s12877-016-0396-x.
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Keywords: Telehealth, Primary Care, Obesity, Rural Health, Elderly
Yawn BP, Rank MA, Bertram SL
Obesity, low levels of physical activity and smoking present opportunities for primary care asthma interventions: an analysis of baseline data from the asthma tools study.
The researchers calculated cross-sectional frequencies of activity levels, smoking, secondhand smoke exposure and the presence of obesity, as well as rates of out-of-control asthma and asthma exacerbations. They found that tobacco smoke exposure, obesity, low activity levels, poverty, inadequately controlled asthma and high asthma-related health-care utilization were common. Across all age groups, obesity was associated with poorer asthma outcomes.
AHRQ-funded; HS018431.
Citation: Yawn BP, Rank MA, Bertram SL .
Obesity, low levels of physical activity and smoking present opportunities for primary care asthma interventions: an analysis of baseline data from the asthma tools study.
NPJ Prim Care Respir Med 2015 Oct 1;25:15058. doi: 10.1038/npjpcrm.2015.58..
Keywords: Asthma, Obesity, Tobacco Use, Primary Care, Outcomes
Baer HJ, Wee CC, DeVito K
Design of a cluster-randomized trial of electronic health record-based tools to address overweight and obesity in primary care.
The researchers described the design of a trial to examine the effectiveness of electronic health record-based tools for the assessment and management of overweight and obesity among adult primary care patients, as well as the challenges encountered. New features included reminders to measure height and weight, and an alert asking providers to add overweight or obesity to the problem list.
AHRQ-funded; HS019789.
Citation: Baer HJ, Wee CC, DeVito K .
Design of a cluster-randomized trial of electronic health record-based tools to address overweight and obesity in primary care.
Clin Trials 2015 Aug;12(4):374-83. doi: 10.1177/1740774515578132..
Keywords: Health Information Technology (HIT), Primary Care, Obesity, Electronic Health Records (EHRs), Clinician-Patient Communication
Shaikh U, Romano P, Paterniti DA
Organizing for quality improvement in health care: An example from childhood obesity prevention.
The researchers evaluated how the quality improvement (QI) intervention, Healthy Eating Active Living TeleHealth Community of Practice, at 7 rural California clinics addressed the challenges. of preventing and managing obesity and translation of evidence into practice. Key challenges were clinician and staff buy-in, changing ingrained clinical practices, and motivating patient and families. Facilitators included top-down organizational requirements for QI, linkages to local QI resources, and involvement of clinical champions.
AHRQ-funded; HS018567.
Citation: Shaikh U, Romano P, Paterniti DA .
Organizing for quality improvement in health care: An example from childhood obesity prevention.
Qual Manag Health Care 2015 Jul-Sep;24(3):121-8. doi: 10.1097/qmh.0000000000000066.
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Keywords: Quality Improvement, Children/Adolescents, Obesity, Prevention, Primary Care
Mohanan S, Tapp H, McWilliams A
Obesity and asthma: pathophysiology and implications for diagnosis and management in primary care.
This review summarizes existing data that support the pathophysiologic mechanisms underlying the association between obesity and asthma, as well as the current and future state of treatment for the obese patient with asthma. It suggests that evidence of chronic inflammatory response linking obesity and asthma indicates a need to address obesity during asthma management, possibly by using patient-centered approaches such as shared decisionmaking.
AHRQ-funded; HS019946
Citation: Mohanan S, Tapp H, McWilliams A .
Obesity and asthma: pathophysiology and implications for diagnosis and management in primary care.
Exp Biol Med. 2014 Nov;239(11):1531-40. doi: 10.1177/1535370214525302..
Keywords: Obesity, Asthma, Diagnostic Safety and Quality, Primary Care, Chronic Conditions