National Veterans Health Administration MOVE! Weight Management Program Participation During the COVID-19 Pandemic

Kristen E. Gray, PhD, MS; Katherine D. Hoerster, PhD, MPH; Stephanie A. Spohr, PhD, MA; Jessica Y. Breland, PhD; Susan D. Raffa, PhD

Disclosures

Prev Chronic Dis. 2022;19(3):E11 

In This Article

Methods

We conducted a descriptive retrospective cohort study using VHA clinical and administrative data on MOVE! participation from the VHA Support Service Center MOVE! Visits Report. We examined MOVE! participation aggregated at the national level by month from January 2018 through January 2021. We considered the period of March 2020–January 2021 as "during the pandemic" and before March 2020 as "prepandemic." This project was considered quality improvement and, per VHA policy, did not require institutional review board approval or waiver. We obtained a nonresearch determination (per VHA Handbook 1058.05) from the VHA National Center for Health Promotion and Disease Prevention.

MOVE! Participation

We examined several dimensions of MOVE! participation each month, including the number of MOVE! visits, the number of MOVE! participants, and the number of new MOVE! participants. We identified MOVE!-related visits by clinic stop codes, which are administrative codes for identifying outpatient care. The combination of up to 2 stop codes indicated the MOVE! visit format (group [373] vs individual [372]) and the delivery modality. The combination of visit format and delivery modality resulted in more than 100 different stop code pairs.

We defined delivery modality as in person, telephone, Clinical Video Telehealth (clinic-to-clinic), VHA Video Connect (anywhere-to-anywhere [eg, provider home to veteran home]), or TeleMOVE! home telehealth. We also created a composite telehealth category, which aggregated telephone, Clinical Video Telehealth, VHA Video Connect, and TeleMOVE! home telehealth. Telephone involves delivery of the standard in-person MOVE! curriculum via telephone. Clinical Video Telehealth and VHA Video Connect are synchronous video sessions. TeleMOVE! home telehealth is an individual remote education and monitoring program completed by veterans at home using an in-home messaging device, browser-based technology, or mobile device and scale. Veterans receive daily education and transmit weight and other relevant health data for monitoring by a care coordinator, who assists participants with behavior change.

The number of MOVE! participants can include veterans more than once across stop codes. If a veteran has a MOVE! visit with a different stop code in the same month, they contribute data to each combination of stop codes (eg, to individual in-person visits and individual telephone visits). Therefore, totals summed across modalities will overestimate the unique number of participants in each month. Veterans are considered new MOVE! participants when they make their first ever MOVE! visit, and they are counted only once for this dimension of MOVE! participation.

Data Analysis

We examined MOVE! participation from January 2018 through January 2021. We first characterized changes over time in the number of visits, participants, and new participants by MOVE! modality (in-person or telehealth), as well as the monthly distribution of MOVE! participation by modality (eg, percentage of all MOVE! visits attributable to each modality). We further examined trends in participation in each telehealth modality by group format versus individual format. To compare MOVE! participation during the COVID-19 pandemic to typical years, we averaged monthly participation in 2018 and 2019, assigning equal weight to each year, and calculated the percentage change in 2020 relative to the prior years' average for that month. We calculated percentage change in January 2021 relative to the average across January 2019 and 2020, both of which were in the prepandemic period and were most proximal to January 2021 (vs averaging January 2018 and January 2019 for comparisons). We compared data from the same months in prior years because of seasonal variation in MOVE! participation, which precluded comparing data from the height of the pandemic to the months preceding it.

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