Implementation and effectiveness of a care process to prioritize weight management in primary care: a stepped-wedge cluster-randomized trial.

In a stepped-wedge cluster-randomized pragmatic trial in the state of Colorado, USA, 56 primary care clinics were randomly assigned to three clusters with staggered start dates for a one-way crossover from usual care to the intervention phase.

在美国科罗拉多州进行的一项分步楔形群随机实用试验中，56个初级保健诊所被随机分配到三个群组，这些群组有分阶段的开始日期，以便从常规护理向干预阶段进行单向交叉。

The intervention (PATHWEIGH) included three components: (1) health system primary care leadership endorsement; (2) an electronic health record-driven care process designed to prioritize, facilitate and expedite weight management; and (3) implementation strategies to support use of the care process and educate clinicians on obesity treatment.

干预措施（PATHWEIGH）包括三个部分：（1）卫生系统初级保健领导的背书；（2）一个基于电子健康记录的护理流程，旨在优先、促进和加快体重管理；以及（3）实施策略以支持护理流程的使用，并教育临床医生关于肥胖治疗。

The coprimary outcomes were average patient weight loss at 6 months and weight loss maintenance from 6 months to 18 months.

共同的主要结果是患者在6个月时的平均体重减轻以及从6个月到18个月的体重维持。

In total, 274,182 adults with a body mass index ≥25 kg m2 had at least 2 measured weights in one of the clinics between March 2020 and March 2024.

在2020年3月至2024年3月期间，共有274,182名体重指数（BMI）≥25 kg/m2的成年人在诊所至少测量了两次体重。

A counterfactual analysis comparing differences in weight between the intervention and usual care suggests that PATHWEIGH decreased average weight by 0.29 kg (95% confidence interval(CI): 0.27 kg, 0.32 kg) from the first weight to 6 months later (P < 0.001) and 0.28 kg (95% CI: 0.26 kg, 0.31 kg) from 6 months to 18 months (P < 0.001) for a total difference of 0.58 kg (95% CI: 0.54 kg, 0.61 kg; P < 0.001).

通过对比干预组和常规护理组之间的体重差异的反事实分析表明，PATHWEIGH从首次测量体重到6个月后平均减轻体重0.29公斤（95%置信区间（CI）：0.27公斤，0.32公斤）（P<0.001），从6个月到18个月平均减轻体重0.28公斤（95% CI：0.26公斤，0.31公斤）（P<0.001），总共减轻体重0.58公斤（95% CI：0.54公斤，0.61公斤；P<0.001）。

PATHWEIGH increased the likelihood of receiving weight-related care during the intervention (OR = 1.23; 95% CI 1.16, 1.31; P < 0.001).

PATHWEIGH 增加了在干预期间接受与体重相关护理的可能性（比值比=1.23; 95% 置信区间 1.16, 1.31; P < 0.001）。

The intervention was associated with greater weight loss for those receiving weight-related care (adjusted difference of 2.36 kg over 18 months; 95% CI: 2.31 kg, 2.42 kg, P < 0.001), and weight gain was mitigated in the intervention even when patients did not receive weight-related care (adjusted difference of 0.32 kg over 18 months, 95% CI: 0.30 kg, 0.35 kg; P < 0.001).

接受与体重相关护理的患者在干预期间体重减轻更多（18个月内调整后的差异为2.36公斤；95% 置信区间: 2.31公斤, 2.42公斤, P < 0.001），即使患者没有接受与体重相关的护理，干预也减轻了体重增加（18个月内调整后的差异为0.32公斤；95% 置信区间: 0.30公斤, 0.35公斤; P < 0.001）。

Thus, PATHWEIGH is a pragmatic, scalable approach showing favorable impact on population weight.

因此，PATHWEIGH 是一种实用且可扩展的方法，对人群体重产生了有利影响。

ClinicalTrials.gov registration: NCT04678752 .

ClinicalTrials.gov 注册号：NCT04678752 。