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CDA 15-060 – HSR&D Study

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CDA 15-060
Identifying and Addressing Barriers to Bariatric Surgery within VA
Luke M Funk MD MPH
William S. Middleton Memorial Veterans Hospital, Madison, WI
Madison, WI
Funding Period: March 2016 - February 2021

BACKGROUND/RATIONALE:
There are more than 700,000 Veterans with severe obesity (body mass index >=35). These Veterans exert significant costs on the VA system, experience poorer quality of life, and have shortened lifespans. Bariatric surgery is the most effective treatment for severe obesity for weight loss, comorbidity resolution, and quality of life. Yet less than 0.5% of Veterans who qualify for bariatric surgery undergo it. Reasons for low utilization are unclear, although our preliminary research suggests that there are various patient, provider and system level barriers to severe obesity care.

OBJECTIVE(S):
This CDA proposal addresses the VA's urgent need to 1) understand the barriers to severe obesity care within VA; 2) test interventions designed to improve communication between providers and Veterans regarding severe obesity treatment options, including bariatric surgery and behavioral weight management strategies; and 3) characterize management practices surrounding severe obesity care within VA.

METHODS:
Aim 1 will include semi-structured interviews with Veterans with severe obesity and providers who treat them, including PCPs, MOVE! team members and bariatric surgery program members. Facilitators and barriers to bariatric surgery and MOVE! program participation as well as attitudes and experiences of providers and patients who have pursued bariatric surgery in VA will be identified. Aim 2 will include the development, refinement and pilot-testing of a communication tool designed to enhance shared decision-making for severe obesity treatment. For Aim 3, a national survey of VA PCPs will be administered in attempt to understand how PCPs manage severely obese patients and how severely obese patients engage with the MOVE! program.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
The knowledge generated in this CDA will advance our understanding of the patient, provider and work system elements that contribute to low levels of bariatric surgery utilization. This will provide potential targets for optimizing clinical programs, such as MOVE! and bariatric surgery, that offer severe obesity care within the VA. It will also provide information on whether a communication tool designed to enhance shared decision-making is feasible and acceptable to Veterans and providers. Completion of these aims will provide the foundation for a future, multi-site randomized trial, evaluating the efficacy of the communication tool.

PUBLICATIONS:

Journal Articles

  1. Shea GE, Johnson MK, Venkatesh M, Jolles SA, Prout TM, Shada AL, Greenberg JA, Lidor AO, Funk LM. Long-term dysphagia resolution following POEM versus Heller myotomy for achalasia patients. Surgical endoscopy. 2019 Jul 10.
  2. Liu N, Cusack MC, Venkatesh M, Pontes AL, Shea G, Svoboda DC, Greenberg JA, Lidor AO, Funk LM. 30-Day Outcomes After Intraoperative Leak Testing for Bariatric Surgery Patients. The Journal of surgical research. 2019 Oct 1; 242:136-144.
  3. Jolles SA, Alagoz E, Liu N, Voils CI, Shea G, Funk LM. Motivations of Males with Severe Obesity, Who Pursue Medical Weight Management or Bariatric Surgery. Journal of laparoendoscopic & advanced surgical techniques. Part A. 2019 Jun 1; 29(6):730-740.
  4. Kleppe KL, Xu Y, Funk LM, Wang X, Havlena JA, Greenberg JA, Lidor AO. Healthcare spending and utilization following antireflux surgery: examining costs and reasons for readmission. Surgical endoscopy. 2019 Apr 5.
  5. Pooler BD, Wiens CN, McMillan A, Artz NS, Schlein A, Covarrubias Y, Hooker J, Schwimmer JB, Funk LM, Campos GM, Greenberg JA, Jacobsen G, Horgan S, Wolfson T, Gamst AC, Sirlin CB, Reeder SB. Monitoring Fatty Liver Disease with MRI Following Bariatric Surgery: A Prospective, Dual-Center Study. Radiology. 2019 Mar 1; 290(3):682-690.
  6. Taylor LJ, Xu K, Maloney JD, Voils CI, Weber SM, Funk LM, Abbott DE. Deficiencies in postoperative surveillance for veterans with gastrointestinal cancer. Journal of Surgical Oncology. 2019 Mar 1; 119(3):273-277.
  7. Walle KV, Funk LM, Xu Y, Davies KD, Greenberg J, Shada A, Lidor A. Persistent Dysphagia Rate After Antireflux Surgery is Similar for Nissen Fundoplication and Partial Fundoplication. The Journal of surgical research. 2019 Mar 1; 235:52-57.


DRA: Diabetes and Related Disorders, Other Conditions
DRE: Technology Development and Assessment
Keywords: Outcomes - Patient
MeSH Terms: none