No abstract

Background: Among patients with obesity, the subset of patients with severe obesity has been increasing at the fastest rate. Although there is literature which suggests modest effectiveness of weight loss counselling by primary care providers, many primary care clinicians face frustration with the management of obesity. Reasons for this include time constraints, poor reimbursement, and perceived inadequacy or futility of obesity treatments. Despite these obstacles, we hypothesize that primary care clinicians still positively impact weight loss for patients with severe obesity.

This performance improvement initiative used a bundle designed to reduce the COVID-19 infection fatality rate (IFR) by ≥33% and the new infection rate (IR) to <1% among nursing home (NH) residents over a 3-month period at a large public NH in New York City. Participants were all NH residents, newly testing COVID-19 PCR positive between March 1, 2020 and June 30, 2020. Key bundle components involved close observation of all residents with vital signs taken once/shift, including O2 saturation, frequent clinical team follow-up visits for those symptomatic, and ramped-up COVID-19 PCR testing. From April to June, average IFR was 12.3%, a 49.6% reduction from the March baseline (P < 0.05), and average new IR was 5.4%, a 29.9% reduction from baseline (P < 0.05). In the 2 follow-up months, no deaths occurred with a new IR < 1%, indicating sustained improvement. Because of its simplicity, this bundle or components of it could be readily applied elsewhere after appropriate assessment.