A Midpoint Process Evaluation of the Los Angeles Basin Racial and Ethnic Approaches to Community Health Across the US (REACH US) Disparities Center, 2007-2009

BACKGROUND: Racial/ethnic minority groups have higher risks for disease resulting from obesity. COMMUNITY CONTEXT: The University of California, Los Angeles, and the Los Angeles County Department of Public Health partnered with community organizations to disseminate culturally targeted physical activity and nutrition-based interventions in worksites. METHODS: We conducted community dialogues with people from 59 government and nonprofit health and social service agencies to develop wellness strategies for implementation in worksites. Strategies included structured group exercise breaks and serving healthy refreshments at organizational functions. During the first 2 years, we subcontracted with 6 community-based organizations (primary partners) who disseminated these wellness strategies to 29 organizations within their own professional networks (secondary worksites) through peer modeling and social support. We analyzed data from the first 2 years of the project to evaluate our dissemination approach. OUTCOME: Primary partners had difficulty recruiting organizations in their professional network as secondary partners to adopt wellness strategies. Within their own organizations, primary partners reported significant increases in implementation in 2 of the 6 core organizational strategies for promoting physical activity and healthy eating. Twelve secondary worksites that completed organizational assessments on 2 occasions reported significant increases in implementation in 4 of the 6 core organizational strategies. INTERPRETATION: Dissemination of organizational wellness strategies by trained community organizations through their existing networks (train-the-trainer) was only marginally successful. Therefore, we discontinued this dissemination approach and focused on recruiting leaders of organizational networks

The Impact of a Practice Redesign to Improve Self-Management Among Obese Safety Net Patients

There are growing numbers of individuals with at least one chronic disease in the United States, creating a greater need for primary care services despite limited health care resources within safety net clinics. Patient self-management has been studied as a possible solution to improve the efficiency and effectiveness of primary care. In order to work, patients must feel confident in their ability to manage their own health and engage in the decision making process of their care. Providers also need adequate time to spend with patients to provide sufficient information as well as listen to patient concerns. Three safety net clinics in Northern California underwent practice redesigns to enhance care for obese patients and improve their self-management skills. A mixed methods approach was used to assess the effects of the practice redesign on staff, clinicians, and patients. Patients were mailed questionnaires during early and late implementation of the practice redesign. Questionnaire measures included patient-provider communication (based on the CG-CAHPS), patient activation (PAM-13), general health (SF-12v2), physical activity, dietary habits, chronic conditions, and demographic information. Clinical outcome measures from clinic administrative data were merged with patient questionnaire data to evaluate patient outcomes relative to self-reported measures. Key informant interviews were conducted with randomly selected clinic staff and clinicians, also during the same baseline and six-month follow-up periods. Topics included practice change implementation experiences, team activities, interactions with overweight or obese patients, team development activities, and practice characteristics.Higher patient activation was associated with increased odds of regular fruit and vegetable consumption. For physical activity, the presence of comorbidities affected the relationship between patient activation and physical activity. Although the patient-provider relationship had a strong bivariate relationship with patient activation, it did not impact the relationship between patient activation and health behaviors. As seen in previous studies, patient activation was related to systolic blood pressure, diastolic blood pressure and weight. However, the clinical practice redesign only had an effect on diastolic blood pressure. The implementation of a teamlet model within safety net clinics to improve patient health may be feasible, but the composition of the teamlet may need to be modified for financial sustainability. Future change efforts should have support from different levels of management and staff, preferably championed by multiple people to aid the sustainability of the change in the face of staffing changes

The Diabetes Prevention Program for Underserved Populations: A Brief Review of Strategies in the Real World

IN BRIEF This review highlights examples of the translation of the Diabetes Prevention Program (DPP) to underserved populations. Here, underserved populations are defined as groups whose members are at greater risk for health conditions such as diabetes but often face barriers accessing treatment. Strategies to develop and evaluate future DPP translations are discussed

Practical partnered research to improve weight loss among overweight/obese veterans: lessons from the trenches.

BackgroundObesity and obesity-related conditions, such as type 2 diabetes, are a major issue for Veteran health. Veterans Health Administration (VA) researchers and health systems leaders have worked separately and together to provide more effective weight management programs for Veterans. Although randomized clinical trials are often considered the gold standard for establishing efficacy of interventions in controlled circumstances, pragmatic clinical trials (PCTs) provide agility for translation.Main textVA researchers and health system leaders collaboratively designed a PCT to compare the Diabetes Prevention Program (VA-DPP) to usual care (MOVE!®) in promoting weight loss and glycemic control among overweight/obese Veterans with prediabetes. Together, they navigated the tensions that exist between quality improvement and research activities, facing challenges but reaping significant rewards. Early findings led to updated national guidance for delivering obesity treatment in VA.Short conclusionPartnered research and the use of PCTs can be powerful strategies for accelerating evidence-based findings into practice. Collaborative partnerships between researchers and health systems leaders can help enhance and sustain translation in real-world settings

Practical partnered research to improve weight loss among overweight/obese veterans: lessons from the trenches

Abstract Background Obesity and obesity-related conditions, such as type 2 diabetes, are a major issue for Veteran health. Veterans Health Administration (VA) researchers and health systems leaders have worked separately and together to provide more effective weight management programs for Veterans. Although randomized clinical trials are often considered the gold standard for establishing efficacy of interventions in controlled circumstances, pragmatic clinical trials (PCTs) provide agility for translation. Main text VA researchers and health system leaders collaboratively designed a PCT to compare the Diabetes Prevention Program (VA-DPP) to usual care (MOVE!®) in promoting weight loss and glycemic control among overweight/obese Veterans with prediabetes. Together, they navigated the tensions that exist between quality improvement and research activities, facing challenges but reaping significant rewards. Early findings led to updated national guidance for delivering obesity treatment in VA. Short conclusion Partnered research and the use of PCTs can be powerful strategies for accelerating evidence-based findings into practice. Collaborative partnerships between researchers and health systems leaders can help enhance and sustain translation in real-world settings