Article Figures & Data
Figures
- Figure 1
Flow diagram of practice selection for study participation and allocation to traditional and enhanced practices.
a Two practices were combined into a single practice for analysis because of the high degree of overlap in clinicians across the 2 practices.
- Figure 2
Flow diagram of patient allocation to enhanced and traditional practices.
Tables
Variable Enhanced Practice
n=331
No. (%)Traditional Practice
n=279
No. (%)P Valuea Sex, female 255 (77.0) 211 (75.6) .683 Racial background White 186 (56.2) 165 (59.1) .828 African-American 57 (17.2) 46 (16.5) Other 62 (18.7) 45 (16.1) Missing 26 (7.9) 23 (8.2) Ethnicity Not Hispanic/Latino 272 (82.2) 240 (86.0) .198 Hispanic/Latino 59 (17.8) 39 (14.0) Education Less than high school 19 (5.7) 8 (2.9) .330 High school grad/GED 85 (25.7) 74 (26.5) Some college, graduate school 202 (61.0) 171 (61.3) Missing 25 (7.6) 26 (9.3) Income <$20,000 70 (21.1) 55 (19.7) .784 $20,001–$50,000 109 (32.9) 93 (33.3) $51,001–$75,000 50 (15.1) 37 (13.3) $75,001+ 62 (18.7) 63 (22.6) Missing 40 (12.1) 31 (11.1) Marital status Single 53 (16.0) 64 (22.9) .019 Married 204 (61.6) 144 (51.6) Separated, divorced, or widowed 54 (16.3) 60 (21.5) Missing 20 (6.0) 11 (3.9) Number of people in home 1 15 (4.5) 31 (11.1) .017 2 71 (21.5) 48 (17.2) 3–4 98 (29.6) 86 (30.8) 5+ 57 (17.2) 36 (12.9) Missing 90 (27.2) 78 (28.0) -
GED=general equivalency diploma.
-
↵a Variables analysed using χ2 test of association.
-
Variable Enhanced Practice, n=331 Traditional Practice, n=279 P Valuea Mean SD Median Mean SD Median Continuous descriptors, t test, with median 43.5 11.1 44.0 44.3 13.7 45.0 .425 Systolic blood pressure, mm Hg 128.5 15.1 128.0 124.4 16.5 122.0 .002 Diastolic blood pressure, mm Hg 80.5 10.4 80.0 77.2 9.9 79.0 <.001 HOMA-IR log transformation 1.1 0.7 1.1 1.2 0.8 1.1 .088 NMRLP (nmol/L) 1,692 502.8 1,647 1,527 475.0 1,474 <.001 PrimeScreenb AIM-HI −0.1 0.4 −0.1 −0.1 0.4 −0.0 .910 Total MET minutes, square root transformed 24.9 19.7 21.3 27.6 21.2 23.0 .123 Continuous descriptors, nonparametric test BMI 37.0 5.7 35.8 36.8 6.0 35.0 .292 Fitnessc 4.1 2.0 4.0 3.7 1.9 4.0 .034 SF-12 mentald −0.3 1.1 −0.2 −0.3 1.1 −0.1 .522 SF-12 physicald −0.3 0.8 −0.1 −0.4 1.1 −0.2 .385 -
AIM-HI = Americans In Motion—Healthy Interventions; BMI = body mass index. HOMA-IR = homeostatic model assessment: insulin resistance; MET = metabolic equivalent test; NMRLP = nuclear magnetic resonance lipoprotein profiles; SF-12 = SF-12 Health Survey, a short form subset of the SF-36.
-
↵a For BMI, fitness, SF-12 mental, and SF-12 physical we used nonparametric Wilcoxon rank sum test. For systolic and diastolic blood pressures, HOMA-IR, NMRLP, and PrimeScreen, we used analysis of variance.
-
↵b PrimeScreen is a brief dietary screening tool.
-
↵c Scored on a range from 1 to 7, based on heart rate, age, and sex, with higher scores indicating greater physical fitness.
-
↵d Mental or physical component summary scores of the SF-12 Health Survey, a short form subset of the SF-36.
-
- Table 3
Patient Outcomes by Randomized Practice Condition: Mixed Effects Multivariate Regression
Baseline 4 Monthsa 10 Monthsb Outcome by Group Estimate SE Estimate SE Change From Base P Value Estimate SE Change From Base P Value Between- Group Difference P Value BMI Traditional 37.117 0.723 36.861 0.725 .031 36.917 0.726 .107 .966 Enhanced 37.513 0.737 37.296 0.741 .053 37.346 0.740 .133 Systolic BP, mm Hg Traditional 126.317 1.960 128.660 2.015 .022 126.941 2.049 .552 .009 Enhanced 130.391 1.939 128.652 2.020 .071 128.178 2.018 .020 Fitnessc Traditional 3.705 0.341 4.027 0.346 .010 3.810 0.349 .402 .406 Enhanced 4.098 0.333 4.242 0.341 .212 4.256 0.340 .159 PrimeScreend AIM-HI Traditional −0.027 0.042 0.068 0.043 .000 0.106 0.044 .000 .061 Enhanced −0.017 0.043 0.150 0.045 .000 0.168 0.045 .000 SF-12 mentale Traditional −0.072 0.120 0.129 0.123 .007 0.088 0.126 .038 .652 Enhanced −0.112 0.121 0.091 0.128 .003 −0.037 0.129 .275 EQ-5D health state Traditional 65.848 2.610 65.855 2.730 .997 69.309 2.806 .071 .940 Enhanced 66.671 2.636 67.338 2.817 .699 70.935 2.815 .013 -
AIM-HI = Americans In Motion—Healthy Interventions; BMI = body mass index; BP = blood pressure; EQ-5D = A visual analog health state score.
-
Note: Models adjusted for repeated measures, clustering of patients within practices, age, comorbidities, education, sex, income, marital status, race, and ethnicity.
-
↵a Traditional practices, n = 197 patients; enhanced practices, n = 201 patients.
-
↵b Traditional practices, n = 171 patients; enhanced practices, n = 206 patients.
-
↵c Scored on a range from 1 to 7, based on heart rate, age, and sex, with higher scores indicating greater physical fitness.
-
↵d PrimeScreen is a brief dietary screening tool.
-
↵e The mental component summary of the SF-12 Health Survey, a short form subset of the SF-36.
-
Baseline 4-Month (n=398) 10-Month (n=377) Outcome Estimate SE Estimate SE Change From Base P Value Estimate SE Change From Base P Value BMI 36.997 0.331 36.757 0.334 .005 36.795 0.335 .019 Systolic BP 125.486 1.456 125.803 1.506 .651 124.874 1.515 .393 Fitnessa 3.893 0.234 4.130 0.239 .007 4.044 0.239 .077 PrimeScreenb AIM-HI −0.057 0.019 0.079 0.021 .000 0.108 0.022 .000 SF-12 mentalc −0.316 0.054 −0.112 0.060 .000 −0.186 0.062 .014 EQ-5D health stated 64.396 1.359 65.031 1.510 .610 68.597 1.532 .002 -
AIM-HI = Americans In Motion—Healthy Interventions BMI = body mass index; BP = blood pressure; EQ-5D = A visual analog health state score.
-
Note: Models adjusted for repeated measures, clustering of patients within practices.
-
↵a Fitness is scored 1 to 7 based on heart rate, age and sex, with higher scores indicating greater physical fitness.
-
↵b PrimeScreen is a brief dietary screening tool.
-
↵c The mental component summary of the SF-12 Health Survey, a short form subset of the SF-36.
-
↵d Scored from 0% to 100%, with higher scores indicating better state of health.
-
The Article in Brief
Effectiveness of 2 Methods of Promoting Physical Activity, Healthy Eating, and Emotional Well-Being With the Americans in Motion--Healthy Interventions Approach
Wilson D. Pace , and colleagues
Background Americans In Motion--Healthy Interventions (AIM-HI) promotes healthy lifestyle choices related to nutrition, physical activity, and emotional well-being. This study compares patient-level outcomes between family medicine practices using 2 different methods to implement the AIM-HI tools.
What This Study Found There were impressive before and after improvements in patient outcomes but no differences between 2 different approaches to implementing AIM-HI. Pratices used either an enhanced practice approach (used AIM-HI tools to help office staff make personal changes and create a healthy practice environment) or a traditional practice approach (were trained and asked to use the tools directly with patients). There were no significant differences in patient-outcomes between the 2 groups. Regardless of practice group, 16 percent of patients who completed a 10-month visit (378 patients) and 10 percent of all patients enrolled lost 5 percent or more of their body weight. Of the patients who completed a 10-month visit, 17 percent had a 2-point or greater increase in their fitness level and 29 percent lost 5 percent or more of their body weight and/or increased their fitness level by 2 or more points.
Implications
- The lack of difference between the 2 groups may be due to study design, patient selection, the nonprescriptive approach of AIM-HI, and already established physician workplace wellness activities that motivated clinicians to intervene with patients.
