A Comprehensive Practice-Friendly Model for Promoting Healthy Behaviors

Study Overview
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Brief Summary
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Using an electronic health record to link the resources of primary care practices and community programs will help patients to improve their diet and exercise, quit smoking, and moderate their drinking.

Detailed Description
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We posit that practice systems to promote healthy behaviors must combine five attributes to be effective and sustainable. They must be comprehensive (addressing multiple behaviors and the 5 As), flexible (offering options), generalizable to ordinary practices, practice-friendly (limiting burden), and apply the Chronic Care Model. We will test the effectiveness and implementation of an innovative packaged intervention with these features. Six ACORN-affiliated practices will adopt a brief (3 minute) routine to deliver A1-3 (Ask, Advise, Agree) in the office and to offer patients four options for intensive assistance (Assist [A4], Arrange [A5]) outside the office. Patients can select 9 months of online, telephone, or group counseling; or usual care. An electronic health record (EHR) will expedite the in-office intervention and referrals. Outcome measures will include health behaviors (derived from 7200 surveys administered pre-intervention and 3 and 9 months post-exposure) and implementation (derived from EHR data, counselee surveys, and patient/staff interviews). We hypothesize that implementing this novel package of interventions will be associated with improved health behaviors (using the Common Measures for physical activity, diet, smoking, and alcohol use). EHR-captured data will measure RE-AIM parameters, including Reach (14 sub-measures), Adoption, and Maintenance. Surveys and qualitative analysis of semi-structured interviews with patients and office staff will explore Implementation issues and suggested improvements. We hope to demonstrate that this innovative intervention not only promotes healthy behaviors but is feasible and sustainable in primary care. Accomplishing these goals requires a delicate balancing act--deploying evidence-based strategies that are effective in lifestyle change but limit demands for new staff, training, or time. We strike this balance by harnessing effective technologies and tools and by leveraging resources outside the practice. If our intervention helps patients change unhealthy behaviors and is appealing to ordinary practices, we envision the potential for widespread adoption and substantial population health benefits.

Official Title
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A Comprehensive Practice-Friendly Model for Promoting Healthy Behaviors

Conditions
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Unhealthy Diet, Exercise, Smoking, and Alcohol Use

Intervention / Treatment
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* Behavioral: Computer based care
* Behavioral: Telephone counseling
* Behavioral: Group visits
* Behavioral: Usual care


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All individuals over the age of 8 years presenting for care in 9 primary care practices Exclusion Criteria: None

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Intervention/Treatment |
| --- |
|Behavioral: Computer based care|nan|
|Behavioral: Telephone counseling|nan|
|Behavioral: Group visits|nan|
|Behavioral: Usual care|nan|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Health behaviors (diet, exercise, smoking status, and alcohol use |  | 4 and 9 months post intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Intervention's Reach, Adoption, Implementation, Maintenance |  | At the time of delivery of care | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Health Behavior, Prevention, Informatics, Electronic Health Record