All ETDs from UAB

Advisory Committee Chair

Emily B Levitan

Advisory Committee Members

Olivia Affuso

April P Carson

Sara J Knight

Joshua S Richman

Document Type

Dissertation

Date of Award

2017

Degree Name by School

Doctor of Philosophy (PhD) School of Public Health

Abstract

Reducing cardiovascular (CVD) risk factors such as obesity through lifestyle and behavioral interventions like weight management programs should result in better cardiovascular health. However, there is conflicting evidence on the effectiveness of these interventions in reducing long-term CVD outcomes such as acute myocardial infarction or stroke. This reflects an important gap in our understanding about factors affecting recruitment and engagement in these programs and how these factors relate to improvement in long-term cardiovascular health. To address this gap, we will use a retrospective study with up to 11 years of follow up data from the nation’s largest health care system-associated weight management program, Managing Overweight/Obese Veterans Everywhere! (MOVE!). The objectives of the ReACH study are to: 1. Describe variation in hospital and program characteristics of MOVE! across hospitals. 2. Identify hospital and MOVE! components associated with higher patient recruitment and engagement in MOVE!. 3. Examine secular ecologic trends and changes in monthly rates of long-term CVD outcomes before and after implementation of MOVE!. Data collected by the Veterans Health Administration (VHA) on MOVE! will be merged with other hospital characteristics and non-VHA data on community characteristics, including community health, food access and access to care, to create a robust hospital-level dataset. Bivariate statistics and smoothed plotting will be used to describe variation in hospital and program characteristics of MOVE! across hospitals and to identify program and hospital characteristics associated with higher patient recruitment and engagement in MOVE!. A time series analysis with segmented regression will be used to examine changes in monthly rates of long-term CVD outcomes before and after implementation of MOVE! at a hospital. The findings from ReACH have the potential to lead to better cardiovascular health for the population as a whole. They will also provide primary care providers with information needed to develop tailored, better focused, and more efficient lifestyle interventions to reduce long-term CVD outcomes. Finally, ReACH will provide training and lay the ground-work for a future, patient-level assessment of the effectiveness of MOVE!.

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