Department of Dietetics, National University Hospital, Singapore, Singapore.
Department of Medicine, National University Hospital, Singapore, Singapore.
Endocrinol Diabetes Metab. 2024 May;7(3):e00485. doi: 10.1002/edm2.485.
The prevalence and healthcare cost of metabolic dysfunction-associated steatotic liver disease (MASLD) has increased alongside the epidemic surge in obesity and Type 2 diabetes. Weight loss through lifestyle modification remains the primary effective therapy for MASLD. Incorporation of mobile technology in lifestyle interventions has been previously found to be efficacious and cost-effective in facilitating weight loss. However, there is a paucity of studies that have successfully translated lifestyle research into clinical service for weight loss to alleviate disease burden. Our study aimed to describe the process of translating a mobile technology-enabled trial into a tertiary hospital outpatient dietetics service for patients with MASLD.
The Iowa Model of Evidence-Based Practice to Improve Quality Care was used as a framework for this paper to guide implementation at the organizational level.
Regular engagement of key operational staff and the hospital management team facilitated open discussions of the challenges faced and enabled rapid implementation of strategies that contributed to the smooth piloting of the service. A service adoption rate of 81% was achieved. Preliminary outcome evaluation found that the percentage of patients achieving ≥ 5% weight loss from baseline at 6 months was comparable at 54% and 52% for the service and trial groups, respectively.
Evaluation of the implementation process found that a hybrid model of care (in-person consultation supplemented with app coaching) preserved interpersonal connections while maximizing the convenience and scalability of mobile app-enabled service. Although high digital acceptance and adoption rates propelled by COVID-19-supported telehealth, it is prudent to assess patient's access to technology and digital literacy and offer resources to help them benefit from telehealth services.
代谢功能障碍相关脂肪性肝病（MASLD）的患病率和医疗保健费用随着肥胖和 2 型糖尿病的流行而增加。通过生活方式改变来减肥仍然是 MASLD 的主要有效治疗方法。先前的研究表明，将移动技术纳入生活方式干预措施在促进减肥方面是有效且具有成本效益的。然而，将生活方式研究成功转化为临床服务以减轻疾病负担的研究甚少。本研究旨在描述将一种基于移动技术的试验转化为 MASLD 患者的三级医院门诊饮食服务的过程。
本研究采用爱荷华州基于证据的实践模型来改善医疗质量作为框架，指导在组织层面的实施。
定期与关键运营人员和医院管理团队进行接触，促进了对所面临挑战的公开讨论，并使实施有助于服务顺利试点的策略得以迅速实施。服务的采用率达到 81%。初步结果评估发现，在 6 个月时，从基线开始体重减轻≥5%的患者百分比在服务组和试验组中分别为 54%和 52%，两者相当。
对实施过程的评估发现，混合护理模式（补充应用程序指导的面对面咨询）在保留人际联系的同时，最大限度地提高了基于移动应用程序的服务的便利性和可扩展性。尽管 COVID-19 支持的远程医疗推动了高数字接受率和采用率，但明智的做法是评估患者获得技术和数字扫盲的情况，并提供资源帮助他们从远程医疗服务中受益。
