Affiliation:
1. Department of Surgery, Boston Medical Center Boston University Chobanian & Avedisian School of Medicine Boston Massachusetts USA
2. Department of Cardiovascular Medicine University of Arizona College of Medicine Tucson Tucscon Arizona USA
3. Research Informatics Boston Medical Center Boston Massachusetts USA
4. The MITRE Corporation McLean Virginia USA
5. Uniformed Services University of the Health Sciences Bethesda Maryland USA
Abstract
AbstractObjectiveThis study aimed to determine the important clinical management bottlenecks that contribute to underuse of weight loss surgery (WLS) and assess risk factors for attrition at each of them.MethodsA multistate conceptual model of progression from primary care to WLS was developed and used to study all adults who were seen by a primary care provider (PCP) and eligible for WLS from 2016 to 2017 at a large institution. Outcomes were progression from each state to each subsequent state in the model: PCP visit, endocrine weight management referral, endocrine weight management visit, WLS referral, WLS visit, and WLS.ResultsBeginning with an initial PCP visit, the respective 2‐year Kaplan‐Meier estimate for each outcome was 35% (n = 2063), 15.6% (n = 930), 6.3% (n = 400), 4.7% (n = 298), and 1.0% (n = 69) among 5876 eligible patients. Individual providers and clinics differed significantly in their referral practices. Female patients, younger patients, those with higher BMI, and those seen by trainees were more likely to progress. A simulated intervention to increase referrals among PCPs would generate about 49 additional WLS procedures over 3 years.ConclusionsThis study discovered novel insights into the specific dynamics underlying low WLS use rates. This methodology permits in silico testing of interventions designed to optimize obesity care prior to implementation.
Funder
Boston Medical Center
National Institute of General Medical Sciences
Subject
Nutrition and Dietetics,Endocrinology,Endocrinology, Diabetes and Metabolism,Medicine (miscellaneous)