title: Evaluation of care management intensity and bariatric surgical weight loss.
abstract: OBJECTIVE
  To examine the effect of pre- and postoperative care management on weight loss following bariatric surgery.
  
  
  METHODS
  We conducted a retrospective cohort study supplemented by cross-sectional surveys across 9 bariatric surgery centers.
  
  
  METHODS
  Based on the intensity of patient contact, care management intensity (CMI) was defined as high, moderate, or low for preoperative programs, and high or low for postoperative programs. Multivariable linear regression assessed 1- and 2-year post operative weight loss as a function of CMI.
  
  
  RESULTS
  In the 9 centers, 4433 individuals underwent Roux-en-Y gastric bypass or adjustable gastric band placement between 2005 and 2009. Two sites had low, 5 had moderate, and 2 had high preoperative CMI; 5 sites had low and 4 had high postoperative CMI. In analyses stratified by procedure and adjusted for multiple covariates including site, we found no statistically significant associations between either preoperative or postoperative CMI and post operative change in body mass index at year 1 or year 2. Results were limited by heterogeneity of care management across sites and an inability to assess adherence to care management programs.
  
  
  CONCLUSIONS
  Prospective investigations that incorporate quantifiable measures of CMI and measure individual adherence to components of care management programs are needed to more accurately determine the effect of care management on weight loss. Additional investigations should examine the effect of CMI on other relevant outcomes, such as nutritional status and quality of life, that may be more directly affected by care management.
authors.affiliation: University of Colorado Anschutz Medical Campus, 1775 Aurora Ct, Mail Stop A140, Aurora, CO 80045. E-mail: Sarit.Polsky@ucdenver.edu.
authors.forename: Sarit
authors.initials: S
authors.lastname: Polsky
authors.forename: William T
authors.initials: WT
authors.lastname: Donahoo
authors.forename: Ella E
authors.initials: EE
authors.lastname: Lyons
authors.forename: Kristine L
authors.initials: KL
authors.lastname: Funk
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Elliott
authors.forename: Rebecca
authors.initials: R
authors.lastname: Williams
authors.forename: David
authors.initials: D
authors.lastname: Arterburn
authors.forename: Jennifer D
authors.initials: JD
authors.lastname: Portz
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Bayliss
mesh_terms: D000328:Adult; D050110:Bariatric Surgery; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003697:Delphi Technique; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011300:Preoperative Care; D012189:Retrospective Studies; D014481:United States; D015431:Weight Loss