Eboni Price-Haywood, MD, MPH

OXIHER Director, Associate Professor, Oschner Health

Promoting Successful Weight Loss in Primary Care in Louisiana Using Information Technology (PROPEL-IT)

Type 2 diabetes is a major health concern in the United States, and underserved and minority populations share a disproportionate amount of the burden. Further, the Deep South has higher rates of obesity, diabetes, and other chronic conditions than other regions. Modest weight loss can significantly improve cardiometabolic risk and several health outcomes in patients with diabetes. Promoting Successful Weight Loss in Primary Care in Louisiana Using Information Technology (PROPEL-IT) study will examine the effectiveness of integrating primary care with a health coach who remotely delivers care, facilitated by the patient portal of an electronic medical record (EMR), in Black patients with obesity and type 2 diabetes. We will also assess the contextual factors of the intervention settings that may influence utilization and dissemination of the weight loss intervention.

The study group will include Black primary care patients aged 18-70 years with obesity and type 2 diabetes. We will randomly assign 352 individuals equally to an EMR-facilitated behavioral weight loss intervention and a usual care group for 24 months. Patients in the weight loss group will receive a comprehensive, high-intensity behavioral weight loss program delivered by a health coach using interactive electronic health (eHealth) technology including video conferencing, with a strong emphasis on bi-directional communication. Through an EMR patient portal, patients will have access to program materials and personalized weight loss graphs to track their progress. Patients in the usual care group will continue to receive routine medical care by their primary care practitioner.

We hypothesize that patients in the weight loss group will have greater and clinically significant percent reductions in body weight compared to patients in the usual care group. We further hypothesize that patients in the weight loss group will have greater improvements in secondary outcomes, including fasting plasma glucose, hemoglobin A1c, cardiovascular disease risk factors, and patient-reported outcomes such as medication use, sleep quality, mobility, dietary intake, physical activity, and quality of life. Finally, we will study the implementation of the intervention using focus groups, semi- structured interviews, and cost-effectiveness analysis in order to better understand external validity and implementation outcomes. PROPEL-IT study will significantly advance the translation of evidence-based weight loss strategies into primary care that are widely applicable to the growing diabetes population in the United States, particularly in the Deep South.

Disease focus: obesity treatment, diabetes management
Study population: Urban Black adults with obesity and diabetes within a large health system in Louisiana (LA)
Study setting & non-academic partner: Ochsner Health System, a safety net care provider for >950,000 patients in and around New Orleans, a majority of whom are low-income and racial/ethnic minority
Study design: Hybrid type 1 implementation trial; Intervention description: Remotely-delivered weight loss program using patient portals through the EMR and augmented with health coaches embedded in primary care
Levels of action:
1) individual (transportation, support for healthy behaviors)
2) interpersonal/ organizational (communication with the health care team, remote monitoring capacity, systematized outreach and education), and
3) Community (access to health care services)

PROPEL-IT Research Project Status (NCT05523375): Recruiting participants. For more information, visit clinicaltrials.gov.