SBIR-STTR Award

Though the USPSTF recommends all clinicians intervene with obese adults (AHRQ, 2003), less than half of patients are assessed, counseled, or otherwise treated for obesity. This project will create an innovative web-based continuing professional development program for primary care providers (PCPs) available at: //www.ImpactObesity.com to improve PCP care of obese adults. Existing educational paradigms favor didactic learning over skills training and have been ineffective in improving PCP core competencies. The ImpactObesity.com program will instead focus on teaching core physician competencies related to assessment and treatment of adult obesity, identifying potential practice improvements, and guiding implementation of these improvements. Key areas such as lack of physician confidence in treating obesity, negative attitudes towards overweight and obese patients, and barriers such as reimbursement issues and limited time will be addressed. Program materials will include performance improvement guides, patient health improvement tools, a resource center, and approximately 4 hours of AMA PRA Category 1 Credit". Innovation: The ImpactObesity.com program will be tailored to the learner's professional experience/training and practice setting, yielding an individualized training program. Innovation in both instructional design and functionality will be seen in 1) interactive clinical case scenarios that include a simulated electronic medical record (sEMR) for clinical queries, and 2) remote live standardized patient (RLSP) interviews performed via Internet chat. Through the RLSP users are able to practice specific clinical skills (e.g., screening or discussing weight issues). Feedback based on the RLSP will far surpass standard correct/incorrect answers and instead identify deficiencies and recommended response to areas of low performance. Investigators/Consultants: The investigators and company have expertise in developing, deploying and supporting web-based training for health professionals. An expert panel will oversee content creation and training to ensure it focuses on best practice. Approach: Phase I will develop the curriculum with a carefully planned formative analysis involving literature review, target audience needs analysis surveys, semi-structured interviews, an active expert panel, and usability testing of a prototype. At the completion of Phase I, the expert panel will assess if Phase I milestones have been met and if the project should proceed. Deficiencies will be addressed, and the results presented to the expert panel for re-review. An evaluative study in Phase II will assess if the intervention improves PCP's core competencies and demonstrates better training as shown by competency, performance, clinical, and communication skills related to obesity prevention and treatment. When physicians act to integrate specific, step-by-step, measurable improvements into their practices, patient outcomes will ultimately be improved.

Public Health Relevance:
Primary care providers (PCPs) are positioned to assist the one third of Americans who are obese as well as adult patients at risk for obesity - yet there is a dramatic practice gap between the recommended care and the care that patients are receiving. Since less than half of patients are assessed, counseled, or otherwise treated for obesity, Web-based training for health professionals in the proper assessment of overweight patients, screening and treatment for comorbid disorders, and appropriate communication could have a significant and dramatic effect on the obesity epidemic. At this time, no such training exists;there is no program available to health professionals that offers a scalable, cost-effective, solution focusing on improving practice and impacting patient outcomes.

Thesaurus Terms:
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The dire implications of the adult obesity epidemic grow worse over time. Despite front page coverage and universal agreement that the epidemic in weight gain and secondary disease establishment must be addressed, the problem continues. Intended Impact: We propose to improve outcomes of patients with obesity or at risk for obesity via a PC/mobile web-based product called ImpactObesity.com that delivers coordinated tools for: 1. providers to enhance their clinical skills and effect practice change through deliberate practice via case-based simulation training, and, 2. adult patients to work with their providers to manage weight and health issues by providing integrated tools based on standardized instruments and existing training resources to track weight, circumference, diet, and activity, b) graph changes over time, and c) communicate that data as well as experience with the providers 3. clinic leaders and health care organizations to implement the program Phase I successfully demonstrated product feasibility and acceptability of proceeding with Phase II by: 1. Integrating the comments from the prior review of Phase I into the work done in Phase I and the Phase II proposal 2. Completing target audience needs analysis surveys and semi-structured interviews, working with consultants, and creating the curriculum framework and prototype (located at www.ImpactObesity.com), 3. Demonstrating acceptability and usability for PCPs via a usability study and a small pilot study 4. Recruiting clinic locations for the Phase II summative study. 5. Coordinating an expert panel assessment that in turn expressed confidence that the project should proceed Phase II completes the program, finalizes clinic locations for summative study, and evaluates the program using a randomized, wait-list control design. We will assess if the intervention improves health professionals'core competencies and demonstrates better training as shown by competency, performance, clinical, and communication skills and improved treatment behavior related to obesity prevention. A parallel study will assess patient outcomes. Working in sync, patients and primary care providers can be active participants in slowing and eventually reversing the trend.

Public Health Relevance:
Approximately 1/3 of American adults are considered obese (body mass index [BMI] >30), and slightly more are overweight (BMI over 25). Obesity increases the risk of a number of chronic diseases, including coronary heart disease, type 2 diabetes, and certain forms of cancer and is associated with disability and premature death. Our ImpactObesity.com PC/mobile web-based product impacts patients with overweight and obesity via: 1) deliberate practice-based training of providers, 2) a data collection tool for patients, an 3) improved communication between patients and providers. Via this unique capability, this project can improve the health and wellness of patients with overweight and obesity and address the growing and enormous public health challenge of adult obesity and its medical consequences.