2012 HSR&D/QUERI National Conference Abstract
1100 — Evaluation of CCHT-Weight Management (Tele-MOVE) Program Implementation
Goodrich DE, Davis JA, Elliott HA, Damschroder LJ, and Lowery JC, Center for Clinical Management Research, VA Ann Arbor Healthcare System; Richardson CR, Center for Clinical Management Research, VA Ann Arbor Healthcare System; University of Michigan Medical School;
Approximately 1 in 3 Veterans in the VA health system are obese and at high risk for obesity-related comorbidities such as type-2 diabetes. The Care Coordination Home Telehealth – Weight Management (CCHT-WM) program is a home-based 82-day curriculum that utilizes in-home messaging devices to help obese Veterans lose weight. Diabetes QUERI partnered with the National Center for Chronic Disease Prevention and Health Promotion (NCP) to conduct a mixed-methods evaluation of the implementation and effectiveness of the CCHT-WM program.
Nine VA medical centers piloted the program in FY10. We recruited 28 facility- and VISN-level stakeholders to participate in two rounds of semi-structured interviews, first by phone and subsequently onsite about aspects of implementation processes, context, and daily program delivery. Interview questions were guided by the Consolidated Framework for Implementation Research (CFIR). VHA administrative data were used to evaluate program enrollment rates, patient adherence, and clinical outcomes. Weight loss outcomes for Veterans who enrolled in CCHT-WM were compared to Veterans enrolled in MOVE!, VA’s facility-based weight loss program.
Six of nine facilities successfully implemented the pilot as planned and two sites experienced implementation delays. Low enrollment rates were a problem at most sites. At 6 months post-enrollment, mean weight loss was comparable for CCHT-WM (n = 417) and MOVE! (n = 1,543) participants at -5.2 lbs (SD = 14.4) and -5.1 lbs (SD = 12.2), respectively (p = .91). CCHT-WM produced clinically significant weight loss (>= 5% of baseline weight) in 22% of participants. Variability in sites’ implementation effectiveness was associated with prior telehealth weight-loss experience and coordination between CCHT and MOVE personnel. Unexpectedly, stakeholders reported that the primarily automated CCHT-WM program required more program staff time per participant than the standard facility-based MOVE! program.
This study provides preliminary evidence that CCHT-WM helps obese Veterans achieve short-term weight loss. However, findings also suggest recommendations to improve recruitment and enrollment procedures along with strategies to reduce the burden on program staff in order to broaden the reach of the program.
Lessons learned from this CCHT-WM evaluation can be used to improve system design and expand the reach of future home telehealth programs for Veterans.