PATHWEIGH

Pragmatic Weight Management in Primary Care

Keywords

Obesity, eLearning, primary care, weight-prioritized visit, weight loss maintenance

Summary

PATHWEIGH is a process for primary care to provide, and patients to receive, medical assistance with weight loss and weight loss maintenance. PATHWEIGH is NOT a weight loss program, it is a care process that focuses on reducing excess body weight and weight-related medical complications. Patients receive highly individualized, flexible and evolving care based on their needs, access and preference. This care is provided in the comfort and familiarity of primary care where a long-term relationship is key to success.

PATHWEIGH includes a number of tools functional within the Epic electronic health record (EHR) such as:

Special visit type called a weight-prioritized visit that pre-loads the tools and sends the patient a pre-visit questionnaire
disappearing help text (to guide clinical care)
medication algorithm (for appropriate prescribing)
e-consult (for specialist consultation)
guidelines (embedded UpToDate)

The toolset relies on clinical judgement for use of evidence-based treatment methods. An eLearning module with medical education credits supports clinician training on what treatments to select and how to best communicate with patients about weight issues. PATHWEIGH is being studied in a stepped-wedge, covariate-constrained, cluster randomized trial in 57 UCHealth primary care clinics throughout Colorado. Study results are not yet available.

Significance

Obesity is a significant and prevalent disease affecting nearly 42% of U.S. adults. It is associated with over 200 other known diseases and conditions. Although effective treatment in available, it is often not addressed in health care settings. PATHWEIGH seeks to overcome barriers to helping primary care clinical teams help their patients to achieve a healthy weight.

Impact

PATHWEIGH seeks to have impact in all four Translational Science Benefits Model* domains. As an ongoing study, results are not yet available to demonstrate achievement yet in many areas.

Translational Science Benefits Model* Benefits
Demonstrated: Benefits are those that have been observed and verifiable. *Potential*: Benefits are those logically expected with moderate to high confidence
Delivery of evidence-based weight management treatment to patients in primary care clinics through training of clinicians and teams and system supports through the EHR. Demonstrated		Therapeutic Procedures
Created a new visit type and toolset that is accessible through the electronic medical record to support weight management activities being done in a primary care setting. Demonstrated		Software Technologies
Quality of care is enhanced when patients receive evidence-based weight loss care from their primary care team. Most primary care practices struggle to provide the standard of care for weight loss. PATHWEIGH seeks to help care teams deliver a higher level of care. *Potential*		Health Care Quality
PATHWEIGH supports patients making changes in diet, exercise and other habits that promote weight loss. *Potential*		Disease Prevention and Reduction
PATHWEIGH is provided as a care service to patients in the communities served by the participating 57 UCHealth clinics. *Demonstrated*		Community Health Services
By making weight loss care more efficient and effective, PATHWEIGH seeks to improve the experience of providing weight loss care by primary care teams and result in less use of the health care system by healthier patients, reducing health care costs overall. *Potential*		Health Care Delivery
Patients participating in PATHWEIGH may appreciate improved quality of life and increased life expectancy by reduction in other life-threatening conditions such as diabetes, heart disease and cancer and have improvements in mental health and social relationships. *Potential*		Life Expectancy and Quality of Life
If PATHWEIGH is effective in helping patients to achieve and maintain a healthy weight, the benefit is great in terms of social cost reduction from reducing costs effects of diseases associated with obesity. *Potential*		Societal and Financial Costs of Illness
PATHWEIGH is studying the benefits of the program for patients relative to the cost of delivering it. *Potential*		Cost Effectiveness
PATHWEIGH is trademarked by UCHealth and only for use currently by UCHealth while it is being studied. Use of PATHWEIGH may be a licensed product if proven effective. *Potential*		License Agreements
Published manuscripts in the scientific community describing PATHWEIGH and early results demonstrating value to primary care practices and factors related to successful implementation. *Demonstrated*		Scientific Research Reports

*The Translational Science Benefits Model is a framework designed to help public health and clinical scientists demonstrate the impact of their work in the real world. The Translational Science Benefits Model and Translating for Impact Toolkit © 2017-2023, created by the Institute of Clinical and Translational Sciences at Washington University in St. Louis and available at translationalsciencebenefitsmodel.wustl.edu, is licensed under Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0).

Health Equity Implications

PATHWEIGH as currently studied does not have a specific focus on health equity metrics. It is focused on system change to get help with weight management to patients who need it. However, because most weight management programs in the US are available commercially and thus have a cost, often a significant cost, this means access to evidence-based weight loss help is often not attainable to those in rural areas or with less resources. Therefore, by making weight management available within health care settings, the goal is to bring effective treatment to all who need it in a way that is part of healthcare like any other disease. In this way, access to weight management could be available to more underserved patients. Further research will focus on serving these populations if PATHWEIGH is proven beneficial in this initial trial.

Lessons Learned

The PATHWEIGH study is ongoing and final results are not yet available.

Our qualitative results to date indicate that many clinicians and health care teams report benefit from the structure that PATHWEIGH provides including the specific visit type to discuss weight, the training available and the pre-visit questionnaire to facilitate productive conversations around weight by allowing clinicians and patients to work collaboratively to set and monitor progress and goals
PATHWEIGH also provides assistance through a care pathway regarding medications for weight loss which has been very helpful in clinicians navigating the many new weight loss medications available
We have learned that weight management is considered an important topic for primary care and one that patients and care teams feel is important to be included in primary care practice