title: MOVE: weight management program across the Veterans Health Administration: patient- and facility-level predictors of utilization.
abstract: BACKGROUND
  Health care systems initiating major behavioral health programs often face challenges with variable implementation and uneven patient engagement. One large health care system, Veterans Health Administration (VHA), recently initiated the MOVE!® Weight Management Program, but it is unclear if veterans most in need of MOVE!® services are accessing them. The purpose of this study was to examine patient and facility factors associated with MOVE!® utilization (defined as 1 or more visits) across all VHA facilities.
  
  
  METHODS
  Using national administrative data in a retrospective cohort study of eligible overweight (25 < = body mass index (BMI) < 30 and at least one obesity associated comorbidity) and obese (BMI > =30) VHA outpatients, we examined variation in and predictors of MOVE!® utilization in fiscal year (FY) 2010 using generalized linear mixed models.
  
  
  RESULTS
  4.39% (n = 90,230) of all eligible overweight and obese patients using VHA services utilized MOVE!® services at least once in FY 2010. Facility-level MOVE! Utilization rates ranged from 0.05% to 16%. Veterans were more likely to have at least one MOVE!® visit if they had a higher BMI, were female, unmarried, younger, a minority, or had a psychiatric or obesity-related comorbidity.
  
  
  CONCLUSIONS
  Although substantial variation exists across VHA facilities in MOVE!® utilization rates, Veterans most in need of obesity management services were more likely to access MOVE!®, although at a low level. However, there may still be many Veterans who might benefit but are not accessing these services. More research is needed to examine the barriers and facilitators of MOVE!® utilization, particularly in facilities with unusually high and low reach.
authors: Center of Innovation to Implementation, VA Palo Alto Health Care System & Stanford Medical School, 795 Willow Rd, Menlo Park, CA 94025, USA. aaron.delre@va.gov.
authors: Aaron C
authors: AC
authors: Del Re
authors: Matthew L
authors: ML
authors: Maciejewski
authors: Alex H S
authors: AH
authors: Harris
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000628:therapy; D050177:Overweight / Q000628:therapy; D012189:Retrospective Studies; D012737:Sex Factors; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*; D014728:Veterans / Q000706:statistics & numerical data; D061217:Weight Reduction Programs / Q000706:statistics & numerical data*