The Phased Implementation of a National Telehealth Weight Management Program for Veterans: Mixed-Methods Program Evaluation.
No Thumbnail Available
Date
0000-00-00
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
BACKGROUND The burden of obesity is high among US veterans yet many face barriers to engaging in in person facility based treatment programs To improve access to weight management services the Veterans Health Administration VHA developed TeleMOVE a home based 82 day curriculum that utilizes in home messaging devices to promote weight loss in VHA patients facing barriers to accessing facility based services OBJECTIVE The primary aim was to establish preliminary evidence for the program by comparing outcomes for TeleMOVE with standard facility based MOVE weight management services group individual modalities over the evaluation period based on the number of patients enrolled per site and the program s clinical effectiveness as demonstrated by average weight lost per patient The secondary aim was to understand factors influencing TeleMOVE implementation variability across demonstration sites to develop recommendations to improve national program dissemination METHODS We employed a formative mixed methods design to evaluate the phased implementation of TeleMOVE at 9 demonstration sites and compare patient and site level measures of program uptake Data were collected between October 1 2009 and September 30 2011 Patient level program outcomes were extracted from VHA patient care databases to evaluate program enrollment rates and clinical outcomes To assess preliminary clinical effectiveness weight loss outcomes for veterans who enrolled in TeleMOVE were compared with outcomes for veterans enrolled in standard MOVE at each demonstration site as well as with national averages during the first 2 years of program implementation For the secondary aim we invited program stakeholders to participate in 2 rounds of semistructured interviews about aspects of TeleMOVE implementation processes site level contextual factors and program delivery Twenty eight stakeholders participated in audio recorded interviews RESULTS Although stakeholders at 3 sites declined to be interviewed objective program uptake was high at 2 sites delayed high at 2 sites and low at 5 sites At 6 months post enrollment the mean weight loss was comparable for TeleMOVE n 417 and MOVE n 1543 participants at 5 2 lb SD 14 4 and 5 1 lb SD 12 2 respectively P 91 All sites reported high program complexity because TeleMOVE required more staff time per participant than MOVE due to logistical and technical assistance issues related to the devices High uptake sites overcame implementation challenges by leveraging communication networks with stakeholders adapting the program to patient needs whenever possible setting programmatic goals and monitoring feedback of results and taking time to reflect and evaluate on delivery to foster incremental delivery improvements whereas low uptake sites reported less leadership support and effective communication among stakeholders CONCLUSIONS This implementation evaluation of a clinical telehealth program demonstrated the value of partnership based research in which researchers not only provided operational leaders with feedback regarding the effectiveness of a new program but also relevant feedback into contextual factors related to program implementation to enable adaptations for national deployment efforts