Translational Behavioral Medicine

, Volume 1, Issue 4, pp 551–560

RE-AIM evaluation of the Veterans Health Administration’s MOVE! Weight Management Program

  • Leila C Kahwati
  • Trang X Lance
  • Kenneth R Jones
  • Linda S Kinsinger
Article

ABSTRACT

Over one-third of patients treated in the Veterans Health Administration (VHA) are obese. VHA introduced the MOVE! Weight Management Program for Veterans in 2006 to provide comprehensive weight management services. An evolving, periodic evaluation using the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance) has been conducted to gauge success and opportunities for improvement. Key metrics were identified in each RE-AIM dimension. Data were compiled over fiscal years (FY) 2006 through 2010 from a variety of sources including VHA administrative and clinical databases, electronic medical record reviews, and an annual, structured VHA facility self-report. REACH: Screening for obesity and offering weight management treatment to eligible patients increased from 66% to 95% over the past 3 years. MOVE! is currently provided at every VHA hospital facility and at over one-half of VHA community-based outpatient clinics. The percent of eligible patients who participate in at least one weight management visit has doubled since implementation began but has stabilized at 10 to 12%. EFFECTIVENESS: About 18.6% of the 31,854 patients with available weight data who participated in at least two treatment visits between Jul 1, 2008 and Sep 30, 2009 had at least a 5% body weight loss by 6 months as did almost one-third of those who participated in more intense and sustained treatment. By contrast, only 12.5% of a comparison group of patients matched on age, gender, body mass index (BMI) class, and comorbidity status who were not treated with MOVE! had at least a 5% body weight loss. ADOPTION: The median full-time staff equivalent providing weight management services at each facility has increased over time and was 1.76 in FY 2010. IMPLEMENTATION: Staff from multiple disciplines typically provide MOVE!-related care although not all disciplines are involved with providing care at every facility. Group-based treatment has become increasingly utilized, and in FY 2010 it represented 72% of all MOVE!-related visits. Intensity of treatment has increased from an average of 3.6 visits per patient per year in FY 2007 to 4.6 in FY 2010, but more than half of patients have two visits or less. Almost all facilities now report the consistent use of key evidence-based behavioral strategies with patients. MAINTENANCE: While participation in MOVE! by patients continues to grow each year, facility self-reported program staffing and space/equipment challenges are potential barriers to long-term program maintenance. Evidence-based weight management treatment can be delivered at VHA medical centers and community-based outpatient clinics, but the REACH remains limited after several years of implementation. Intense and sustained treatment with MOVE! results in a modest positive impact on short-term weight loss outcomes, but a relatively small proportion of patients engage in this level of care. Increasing reach, improving effectiveness of care, and keeping patients engaged in treatment are areas for future policy, practice, and research.

KEYWORDS

Obesity Overweight Weight management Weight loss Weight reduction Body weight changes Veterans Veterans health Program evaluation Program effectiveness 

Supplementary material

13142_2011_77_MOESM1_ESM.doc (146 kb)
ESM 1(doc 145 kb)

References

  1. 1.
    Das, S. R., Kinsinger, L. S., Yancy, W. S., Jr., Wang, A., Ciesco, E., Burdick, M., et al. (2005). Obesity prevalence among veterans at Veterans Affairs medical facilities. American Journal of Preventive Medicine, 28(3), 291–294.PubMedCrossRefGoogle Scholar
  2. 2.
    Wang, A., Kinsinger, L. S., Kahwati, L. C., Das, S. R., Gizlice, Z., Harvey, R. T., et al. (2005). Obesity and weight control practices in 2000 among veterans using VA facilities. Obesity Research, 13(8), 1405–1411.PubMedGoogle Scholar
  3. 3.
    Nelson, K. M. (2006). The burden of obesity among a national probability sample of veterans. Journal of General Internal Medicine, 21(9), 915–919.PubMedCrossRefGoogle Scholar
  4. 4.
    Almond, N., Kahwati, L., Kinsinger, L., & Porterfield, D. (2008). Prevalence of overweight and obesity among U.S. military veterans. Military Medicine, 173(6), 544–549.PubMedGoogle Scholar
  5. 5.
    Noel, P. H., Copeland, L. A., Pugh, M. J., Kahwati, L., Tsevat, J., Nelson, K., et al. (2010). Obesity diagnosis and care practices in the Veterans Health Administration. Journal of General Internal Medicine, 25(6), 510–516.PubMedCrossRefGoogle Scholar
  6. 6.
    Department of Veterans Affairs. Organizational briefing book. Department of Veterans Affairs; 2010 [11/25/2010]; Available from: http://www4.va.gov/ofcadmin/docs/vaorgbb.pdf.
  7. 7.
    Kinsinger, L. S., Jones, K. R., Kahwati, L., Harvey, R., Burdick, M., Zele, V., et al. (2009). Design and dissemination of the MOVE! Weight-Management Program for Veterans. Preventing Chronic Disease, 6(3), A98.PubMedGoogle Scholar
  8. 8.
    Veterans Health Administration. VHA handboook 1101.1 Managing Overweight and/or Obesity For Veterans Everywhere (MOVE!) Program. Veterans Health Administration, Department of Veterans Affairs; 2006; Available from: http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1396.
  9. 9.
    National Institutes of Health. (1998). Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults—the evidence report. Obesity Research, 6(Suppl 2), 51S–209S.Google Scholar
  10. 10.
    US Preventive Services Task Force. (2003). Screening for obesity in adults: recommendations and rationale. Annals of Internal Medicine, 139(11), 930–932.Google Scholar
  11. 11.
    McTigue, K. M., Harris, R., Hemphill, B., Lux, L., Sutton, S., Bunton, A. J., et al. (2003). Screening and interventions for obesity in adults: summary of the evidence for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 139(11), 933–949.PubMedGoogle Scholar
  12. 12.
    Veterans Health Administration and United States Army MEDCOM. VA/DoD clinical practice guideline for screening and management of overweight and obesity. Veterans Health Administration and United States Army Medical Command; 2006; Available from: http://www.healthquality.va.gov/Obesity_Clinical_Practice_Guideline.asp.
  13. 13.
    Diabetes Prevention Program Research Group. Lifestyle manuals of operations. 1996 [10/26/2010]; Available from: http://www.bsc.gwu.edu/dpp/manuals.htmlvdoc.
  14. 14.
    Glasgow, R. E., Vogt, T. M., & Boles, S. M. (1999). Evaluating the public health impact of health promotion interventions: the RE-AIM framework. American Journal of Public Health, 89(9), 1322–1327.PubMedCrossRefGoogle Scholar
  15. 15.
    Pawson, R., Greenhalgh, T., Harvey, G., & Walshe, K. (2005). Realist review—a new method of systematic review designed for complex policy interventions. Journal of Health Services Research & Policy, 10(Suppl 1), 21–34.CrossRefGoogle Scholar
  16. 16.
    Pronk, N. (2005). Worksite health promotion: the four faces of measurement. ACSM's Health & Fitness Journal, 9(5), 34–36.CrossRefGoogle Scholar
  17. 17.
    Maciejewski, M. L., Liu, C. F., Derleth, A., McDonell, M., Anderson, S., & Fihn, S. D. (2005). The performance of administrative and self-reported measures for risk adjustment of Veterans Affairs expenditures. Health Services Research, 40(3), 887–904.PubMedCrossRefGoogle Scholar
  18. 18.
    Fan, V. S., Maciejewski, M. L., Liu, C. F., McDonnell, M., & Fihn, S. D. (2006). Comparison of risk adjustment measures based on self-report, administrative data, and pharmacy records to predict clniical outcomes. Health Serv Outcomes Res Methodol, 6(1–2), 21–36.CrossRefGoogle Scholar
  19. 19.
    West, A. N., Lee, R. E., Shambaugh-Miller, M. D., Bair, B. D., Mueller, K. J., Lilly, R. S., et al. (2010). Defining "rural" for veterans' health care planning. The Journal of Rural Health, 26(4), 301–309.PubMedCrossRefGoogle Scholar
  20. 20.
    Kahwati L, Lewis M, Kane H, Williams-Piehota P, Nerz P, Jones K, et al. Best practices in the Veterans Health Administration’s MOVE! Weight Management Program. Am J Prev Med. 2011;41(5):in press.Google Scholar

Copyright information

© Society of Behavioral Medicine 2011

Authors and Affiliations

  • Leila C Kahwati
    • 1
  • Trang X Lance
    • 1
  • Kenneth R Jones
    • 1
  • Linda S Kinsinger
    • 1
  1. 1.National Center for Health Promotion and Disease Prevention, Office of Patient Care ServicesVeterans Health AdministrationDurhamUSA

Personalised recommendations