Oddone Eugene Z, Damschroder Laura J, Gierisch Jennifer, Olsen Maren, Fagerlin Angela, Sanders Linda, Sparks Jordan, Turner Marsha, May Carrie, McCant Felicia, Curry David, White-Clark Courtney, Juntilla Karen
Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA; Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA.
VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA.
Contemp Clin Trials. 2017 Apr;55:1-9. doi: 10.1016/j.cct.2017.01.007. Epub 2017 Jan 24.
A large proportion of deaths and many illnesses can be attributed to three modifiable risk factors: tobacco use, overweight/obesity, and physical inactivity. Health risk assessments (HRAs) are widely available online but have not been consistently used in healthcare systems to activate patients to participate in prevention programs aimed at improving lifestyle behaviors.
The goal of this study is to test whether adding telephone-based coaching to use of a comprehensive HRA increases at-risk patients' activation and enrollment into a prevention program compared to HRA use alone.
Participants were randomized to either complete an HRA alone or in conjunction with a telephone coaching intervention. To be eligible Veterans had to have at least one modifiable risk factor (current smoker, overweight/obese, or physically inactive). The primary outcome is enrollment and participation in a prevention program by 6months. Secondary outcomes include change in a Patient Activation Measure and Framingham Risk Score.
This study is the first to test a web-based health risk assessment coupled with a health coaching intervention within a large healthcare system. Results from this study will help the Veterans Health Administration (VHA) implement its national plan to include comprehensive health risk assessments as a tool to engage Veterans in prevention. The results will also inform health systems outside VHA who seek to implement Medicare's advisement that health risk assessment become a mandatory component of care under the Affordable Care Act.
很大一部分死亡和众多疾病可归因于三个可改变的风险因素：烟草使用、超重/肥胖和身体活动不足。健康风险评估（HRA）在网上广泛可得，但在医疗系统中尚未始终如一地用于促使患者参与旨在改善生活方式行为的预防项目。
本研究的目的是测试与单独使用HRA相比，在使用全面的HRA时增加基于电话的指导是否会提高高危患者参与预防项目的积极性和登记率。
参与者被随机分为单独完成HRA或与电话指导干预一起完成HRA。符合条件的退伍军人必须至少有一个可改变的风险因素（当前吸烟者、超重/肥胖或身体活动不足）。主要结果是在6个月时登记并参与预防项目。次要结果包括患者激活测量和弗明汉风险评分的变化。
本研究是首次在大型医疗系统中测试基于网络的健康风险评估与健康指导干预相结合的情况。本研究的结果将有助于退伍军人健康管理局（VHA）实施其国家计划，将全面的健康风险评估作为促使退伍军人参与预防的工具。结果也将为VHA以外寻求实施医疗保险建议（即根据《平价医疗法案》，健康风险评估成为护理的强制性组成部分）的医疗系统提供信息。
