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Implementation of a virtual patient-centered weight loss maintenance behavior competency assessment in adults with obesity

Brunacini, Kevin, DNP, APRN, FNP-C (Student, Owner of The Diet Doc—Independence)

Journal of the American Association of Nurse Practitioners: March 22, 2019 - Volume Online Now - Issue - p
doi: 10.1097/JXX.0000000000000192
Quality Improvement Research: PDF Only

Background: Evidence shows that 95%–98% of individuals who undergo a diet for weight loss purposes will gain back their weight within 5 years.

Local problem: No standardized method exists to assess weight loss maintenance (WLM) behavior competencies in patients who lose weight within a telehealth nutritional counseling private practice. Incorporating this assessment can be used to increase patient self-efficacy and predict a patient's likelihood of long-term weight success.

Methods: A quality improvement project, implementing four rapid plan-do-study-act cycles, was conducted. Each cycle included tests of change related to team and patient engagement, implementation of a WLM assessment, and an audit adherence. Data were analyzed using run charts to evaluate the impact of interventions on outcomes.

Interventions: The clinical team submitted a weekly WLM competency survey. A patient intake form was completed to identify behavior risks, followed by implementation of a WLM assessment in weekly follow-ups. A team adherence audit was completed and submitted every week.

Results: Team WLM competency levels increased 32%, averaging 82% at project conclusion. Completion of the patient intake form reached and held at 100% for the entire duration. Team usage of the WLM assessment peaked at 97%, correlating to increased patient behavior competence by 27.5% as the patient advanced. Team adherence gradually increased, peaking at 100%.

Conclusions: Patient screening forms and audit logs created a standardized process to collect, deliver, and better coordinate care. The findings suggest that patients who embodied higher behavioral competence will have a greater likelihood of sustaining their weight results and become the successful 2%–5% of weight maintainers.

Frontier Nursing University, Hyden, KY

Correspondence: Kevin Brunacini, DNP, APRN, FNP-C, The Diet Doc—Independence, PO Box 906, Independence, KY 41051. Tel: 937-205-6529; E-mail:

Competing interests: The author of this study is the owner of the practice site in which the study was conducted.

Received October 09, 2018

Received in revised form December 13, 2018

Accepted December 18, 2018

© 2019 American Association of Nurse Practitioners
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