PATHWEIGH Tool for Chronic Weight Management Built into EPIC Electronic Medical Record: Methods, Pilot Results and Future Directions

Abstract

Objective: Despite the overwhelming prevalence and health implications of obesity, it is rarely addressed in a health care setting. Providers and patients alike cite innumerable barriers as to the reasons why. The current study provides a framework to systematically address and deconstruct these barriers.Methods: A pilot study was conducted to evaluate the feasibility of the PATHWEIGH weight loss intervention in primary care. The intervention consisted of staff team training, workflow system management and data capture from the electronic medical record (EPIC). Two family medicine clinics in the same health care system were compared in their approach to weight management: PATHWEIGH method vs. Standard of Care (SOC); matched for provider expertise. Statistical analyses examined patient demographics, weight-related comorbidities, baseline weight and weight loss over 18 months.Results: Patients in the PATHWEIGH group (N = 109) vs. SOC (N = 338) were younger (45 vs. 54 years old, p < 0.001), more likely to be female (89% vs. 65%, p < 0.01) and be commercially insured (93% vs. 52%, p < 0.001). The groups were comparable with respect to the numbers of weight-related comorbidities (p = 0.57). Baseline weight was not different between the groups (103.8 vs. 101.5 kg, p = 0.32), but weight lost was significantly greater in the PATHWEIGH group (7.9 kg / 7.2% body weight vs. 2.4 kg / 2.1% body weight SOC, p < 0.001 for both) despite a similar percentage of patients receiving bariatric surgery (10% for both groups, p = 0.99). Anti-obesity medication was more commonly prescribed in PATHWEIGH vs. SOC (79.8 vs. 20.7%, p < 0.001). Conclusion:These preliminary data demonstrate the feasibility and suggest superiority of using PATHWEIGH for weight loss in a primary care setting.

PATHWEIGH, pragmatic weight management in adult patients in primary care in Colorado, USA: study protocol for a stepped wedge cluster randomized trial

“…1 ). One primary care clinic was excluded as it was a pilot test site [ 29 ]. These practices are comprised of approximately 400 clinician full-time equivalents (physician, nurse practitioner, physician assistant) caring for nearly 500,000 patients in diverse geographic and socioeconomic contexts.…”

Baseline Characteristics of PATHWEIGH: A Stepped-Wedge Cluster Randomized Study for Weight Management in Primary Care

“…Pilot work showed a 7.2% body weight decrease for patients with PATHWEIGH vs 2.1% with standard-of-care (SOC) over a period of 18 months. 12 Early success garnered the endorsement of our regional health system leadership to implement PATHWEIGH in all 57 of its primary care clinics, with funding from the National Institutes of Health. The objective of the present analysis was to describe baseline characteristics of qualifying patients at the beginning of the study, to provide insight into the state of weight-management efforts before intervention.…”

An Assessment of Weight Loss Management in Health System Primary Care Practices

“…12,20 With structures and supports in place, patients are achieving weight loss outcomes that have potential to slow the public health trends toward increasing obesity and the resulting comorbid conditions. [21][22][23][24][25][26] Understanding more about what motivates primary care practice members toward providing obesity care and what steps could be taken to overcome perceived barriers is needed. This study reports on a survey completed by practice members at 18 diverse primary care practices in Colorado regarding their perceptions of the importance of obesity care in their practice, what services are currently provided, satisfaction with the care provided, challenges with providing obesity care, and interests in overcoming these challenges.…”