JMIR Publications

ABSTRACT

Background:

Overweight and obesity are America’s number one health concern. The prevalence of obesity in the US is greater than 36%, a rate that has doubled since 1970. As the second most preventable cause of death, obesity is a risk factor for diabetes, cardiovascular disease, stroke, and cancer, all major causes of death. Primary care clinics may be an ideal setting for weight control interventions to help manage and prevent diabetes. The Centers for Medicare and Medicaid Services (CMS) implemented a healthcare procedure coding system code for intensive behavioral therapy (IBT) for obesity within primary care in 2012 to facilitate payment for addressing obesity, which was followed by universal coverage by insurers for IBT for adults in 2013. However, the impact of this coverage on patient-centered outcomes is largely unknown.

Objective:

The overarching goal of this proposal is to understand the comparative effectiveness of obesity counseling as covered by CMS and other insurers in improving weight loss for adults either with or at high risk of type 2 diabetes.

Methods:

The proposed work leverages the novel infrastructure of the Patient-Centered Outcomes Research Institute-funded PaTH Clinical Data Research Network. EHR data will originate from the six PaTH health systems. Specifically, we propose to: Aim 1: Evaluate the impact of universal preventive service coverage for obesity screening and counseling on weight loss, diabetes incidence, and diabetes outcomes, in patients with diabetes or at high risk for diabetes (defined by body mass index (BMI) ≥ 25). We will determine how the annual probability of receiving obesity and/or nutritional counseling changed pre- and post-policy across all insurers in a cohort of patients with diabetes and at high risk for diabetes. Aim 2: CompProposed study timeline is discussed.are patient weight loss and diabetes-related outcomes among those who receive obesity screening and counseling to those who do not, following implementation of preventive service coverage. We will examine post- policy impact of obesity screening and counseling in a cohort of patients with diabetes and at high risk for diabetes. Specific outcomes to be examined include weight loss, diabetes incidence, and diabetes outcomes. Exploratory outcomes will include patient reported outcomes. Further, we will determine patient characteristics, including demographics, and practice characteristics, including provider type. Understanding patient and practice characteristics most likely to engage in obesity counseling can identify best practices and inform how to increase engagement by both patients and providers.

Results:

Proposed study timeline is discussed.

Conclusions:

Given overweight patients are at highest risk for diabetes, improved weight management services could prevent diabetes and its negative health outcomes. Comparing weight and diabetes outcomes in three states using EHR and claims data before and after this policy was implemented using the PaTH Network will allow important insight into policy effectiveness. Clinical Trial: https://register.clinicaltrials.gov/ Record NCT02788903