Obesity Management Study

Study Description and Methods

Background: This project brought together the AAFP’s public health initiative, Americans in Motion-Healthy Interventions (AIM-HI) and the YMCA of Greater Providence. The study evaluated a practice improvement program to improve family physicians’ ability to engage community resources and link to existing, evidence-based obesity prevention programs, the YMCA Diabetes Prevention Program (DPP), or the YMCA Healthy Lifestyle program (HLP).

Overview of Methods: This 24-month demonstration project examined a quality improvement project that links 5 to 7 primary care practices to an existing community resource at the YMCA in Greater Providence, Rhode Island. It used a multiple time trial quasi-experimental design with a mixed methods analysis to evaluate primary outcomes at the practice level and secondary outcomes at the patient level. Practices (n=5 to 7) were recruited at one time point and evaluated as the unit of analysis. Patients (n=12-20 per practice) were be recruited by practices using a rolling recruitment strategy and evaluated at the patient level accounting for nesting within practices. Control participants from an original pilot study of the YMCA-DPP were used as a retrospective control group and were supplemented by two additional groups of patients within each office, those that are referred to the community resource but do not engage and those that attend educational activities within the practices but do not seek a referral to the community resource.

Specific Aims and Objectives

The specific aims of this project were:

• Aim 1: Engage community resources (YMCA staff) to foster a lifestyle change environment within 5 to 7 primary care practices using an existing, evidence-based quality improvement (QI) initiative while simultaneously working with the practices to create a linkage to an existing, evidence-based obesity prevention program and other services offered at the local YMCA.
• Aim 2: Develop and document a sustainable, replicable referral and feedback mechanism whereby primary care practices and the YMCA collaborate to guide eligible patients to the existing obesity prevention program and other YMCA resources; track the health outcomes and behaviors of patients who participate; and integrate the community resource as part of the established “medical neighborhood.”
• Aim 3: Evaluate the effectiveness of the community linkage QI program at the patient level by assessing de-identified data collected by the YMCA and practices at 4 and 8 months (body weight, blood pressure, participation at the YMCA); and at the practice level by assessing sustainability and potential for dissemination through pre- and post-intervention site visits and key informant interviews.

Timeline

This project was funded from September 2010 through September 2012.

Status

This project is complete. Please see key finding below, with a link to the available toolkit.

Toolkit

In collaboration with the State Networks of Colorado Ambulatory Practices and Partners (SNOCAP-USA) and the YMCA, the AAFP NRN is extremely happy to share the Linking Primary Care Patients to Local Resources for Better Management of Obesity Toolkit.

The management of obesity toolkit is intended to offer broad ideas based in actual practice experience. It is the hope that clinicians and staff at every level of a practice should review the toolkit, as each member contributes to patient care, and customize the concepts for their own specific needs.

The toolkit is in the public domain and may be used and reprinted without permission.

The information contained in this toolkit was collected thanks to the generous involvement of the primary care practice who freely shared their experiences for the benefit of others.

Contact Information

For additional information about this study, please contact:

AAFP National Research Network
1-800-274-2237, x3180
nrn@aafp.org

This project was supported by a task order from the Agency for Healthcare Research and Quality (AHRQ).