一项管理式医疗肥胖干预对临床结局和成本的影响：一项前瞻性观察性研究。
The impact of a managed care obesity intervention on clinical outcomes and costs: a prospective observational study.
作者信息
Rothberg Amy E, McEwen Laura N, Fraser Tom, Burant Charles F, Herman William H
机构信息
Department of Internal Medicine, University of Michigan, Michigan, USA.
出版信息
Obesity (Silver Spring). 2013 Nov;21(11):2157-62. doi: 10.1002/oby.20597. Epub 2013 Oct 17.
OBJECTIVE
To evaluate the impact of a managed care obesity intervention that requires enrollment in an intensive medical weight management program, a commercial weight loss program, or a commercial pedometer-based walking program to maintain enhanced benefits.
DESIGN AND METHODS
Prospective observational study involving 1,138 adults with BMI ≥ 32 kg m(-2) with one or more comorbidities or BMI ≥ 35 kg m(-2) enrolled in a commercial, independent practice association-model health maintenance organization. Body mass index, blood pressure, lipids, HbA1c or fasting glucose, and per-member per-month costs were assessed 1 year before and 1 year after program implementation.
RESULTS
Program uptake (90%) and 1 year adherence (79%) were excellent. Enrollees in all three programs exhibited improved clinical outcomes and reduced rates of increase in direct medical costs compared to members who did not enroll in any program.
CONCLUSIONS
A managed care obesity intervention that offered financial incentives for participation and a variety of programs was associated with excellent program uptake and adherence, improvements in cardiovascular risk factors, and a lower rate of increase in direct medical costs over 1 year.
目的
评估一项管理式医疗肥胖干预措施的影响，该措施要求参与者加入强化医学体重管理项目、商业减肥项目或基于计步器的商业步行项目以维持额外福利。
设计与方法
前瞻性观察性研究，纳入了1138名体重指数（BMI）≥32 kg/m²且患有一种或多种合并症或BMI≥35 kg/m²的成年人，他们均加入了一家商业性、独立执业协会模式的健康维护组织。在项目实施前1年和实施后1年评估体重指数、血压、血脂、糖化血红蛋白（HbA1c）或空腹血糖以及人均每月费用。
结果
项目参与率（90%）和1年依从率（79%）都很高。与未参加任何项目的成员相比，所有三个项目的参与者临床结局均有所改善，直接医疗费用的增长率降低。
结论
一项为参与提供经济激励并提供多种项目的管理式医疗肥胖干预措施，与良好的项目参与率和依从率、心血管危险因素的改善以及1年内直接医疗费用较低的增长率相关。
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