National Center for Health Promotion and Disease Prevention, Office of Patient Care Services, Veterans Health Administration, Durham, NC USA.
Transl Behav Med. 2011 Dec;1(4):551-60. doi: 10.1007/s13142-011-0077-4.
Over one-third of patients treated in the Veterans Health Administration (VHA) are obese. VHA introduced the MOVE! Weight Management Program for Veterans in 2006 to provide comprehensive weight management services. An evolving, periodic evaluation using the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance) has been conducted to gauge success and opportunities for improvement. Key metrics were identified in each RE-AIM dimension. Data were compiled over fiscal years (FY) 2006 through 2010 from a variety of sources including VHA administrative and clinical databases, electronic medical record reviews, and an annual, structured VHA facility self-report. REACH: Screening for obesity and offering weight management treatment to eligible patients increased from 66% to 95% over the past 3 years. MOVE! is currently provided at every VHA hospital facility and at over one-half of VHA community-based outpatient clinics. The percent of eligible patients who participate in at least one weight management visit has doubled since implementation began but has stabilized at 10 to 12%.
About 18.6% of the 31,854 patients with available weight data who participated in at least two treatment visits between Jul 1, 2008 and Sep 30, 2009 had at least a 5% body weight loss by 6 months as did almost one-third of those who participated in more intense and sustained treatment. By contrast, only 12.5% of a comparison group of patients matched on age, gender, body mass index (BMI) class, and comorbidity status who were not treated with MOVE! had at least a 5% body weight loss. ADOPTION: The median full-time staff equivalent providing weight management services at each facility has increased over time and was 1.76 in FY 2010.
Staff from multiple disciplines typically provide MOVE!-related care although not all disciplines are involved with providing care at every facility. Group-based treatment has become increasingly utilized, and in FY 2010 it represented 72% of all MOVE!-related visits. Intensity of treatment has increased from an average of 3.6 visits per patient per year in FY 2007 to 4.6 in FY 2010, but more than half of patients have two visits or less. Almost all facilities now report the consistent use of key evidence-based behavioral strategies with patients. MAINTENANCE: While participation in MOVE! by patients continues to grow each year, facility self-reported program staffing and space/equipment challenges are potential barriers to long-term program maintenance. Evidence-based weight management treatment can be delivered at VHA medical centers and community-based outpatient clinics, but the REACH remains limited after several years of implementation. Intense and sustained treatment with MOVE! results in a modest positive impact on short-term weight loss outcomes, but a relatively small proportion of patients engage in this level of care. Increasing reach, improving effectiveness of care, and keeping patients engaged in treatment are areas for future policy, practice, and research.
评估退伍军人健康管理局（VHA）实施的 MOVE！减肥计划的实施情况，该计划为退伍军人提供综合减肥服务。
使用 RE-AIM 框架（涵盖范围、效果、采用、实施和维持）对计划进行了定期评估，以评估其成功情况和改进机会。在每个 RE-AIM 维度中都确定了关键指标。数据来自 2006 财年至 2010 财年的各种来源，包括 VHA 行政和临床数据库、电子病历审查以及年度结构化 VHA 设施自我报告。
过去 3 年中，对肥胖进行筛查并向符合条件的患者提供减肥治疗的比例从 66%增加到 95%。目前，MOVE！在每个 VHA 医院设施和超过一半的 VHA 社区门诊提供。自实施以来，参加至少一次减肥治疗的符合条件的患者比例增加了一倍，但稳定在 10%至 12%。
在 2008 年 7 月 1 日至 2009 年 9 月 30 日期间参加了至少两次治疗的 31854 名有可用体重数据的患者中，约有 18.6%的患者在 6 个月时体重减轻了至少 5%，而参加更密集和持续治疗的患者中，几乎有三分之一的患者达到了这一目标。相比之下，在年龄、性别、体重指数（BMI）类别和合并症状况相匹配但未接受 MOVE！治疗的对照组患者中，只有 12.5%的患者体重减轻了至少 5%。
每个设施提供减肥服务的全职员工当量中位数随着时间的推移而增加，在 2010 财年达到 1.76。
虽然并非所有学科都参与到每个设施的治疗中，但来自多个学科的工作人员通常会提供与 MOVE！相关的护理。群体治疗的应用越来越广泛，在 2010 财年，它占所有 MOVE！相关就诊的 72%。治疗的强度从 2007 财年每位患者每年平均 3.6 次就诊增加到 2010 财年的 4.6 次，但超过一半的患者就诊次数为两次或更少。现在几乎所有的设施都报告说，始终如一地对患者使用基于证据的行为策略。
尽管患者对 MOVE！的参与度逐年增加，但设施自我报告的项目人员配备和空间/设备方面的挑战可能是长期计划维持的障碍。基于证据的减肥治疗可以在 VHA 医疗中心和社区门诊提供，但在实施多年后，其覆盖范围仍然有限。通过 MOVE！进行密集和持续的治疗会对短期减肥效果产生适度的积极影响，但只有相对较少的患者接受这种治疗。增加覆盖范围、提高护理效果和让患者参与治疗是未来政策、实践和研究的重点领域。
