{"id":"https://openalex.org/W7225792970","doi":"https://doi.org/10.3389/fpubh.2026.1969770","title":"Reverse the odds: a national primary care-embedded cardiometabolic risk identification and care linkage program in Saudi Arabia: an early implementation evaluation","display_name":"Reverse the odds: a national primary care-embedded cardiometabolic risk identification and care linkage program in Saudi Arabia: an early implementation evaluation","publication_year":2026,"publication_date":"2026-11-11","ids":{"openalex":"https://openalex.org/W7225792970","doi":"https://doi.org/10.3389/fpubh.2026.1969770"},"language":"en","primary_location":{"id":"doi:10.3389/fpubh.2026.1969770","doi":"https://doi.org/10.3389/fpubh.2026.1969770","is_oa":true,"landing_page_url":"https://doi.org/10.3389/fpubh.2026.1969770","pdf_url":"https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2026.1969770/pdf","source":{"id":"https://openalex.org/S2595931848","display_name":"Frontiers in Public Health","issn_l":"2296-2565","issn":["2296-2565"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["anvur-scientific","cwts-core","doaj","medline","norway-1","poland-100","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320527","host_organization_name":"Frontiers Media","host_organization_lineage":["https://openalex.org/P4310320527"],"host_organization_lineage_names":["Frontiers Media"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Frontiers in Public Health","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref","doaj"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2026.1969770/pdf","any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5068400366","display_name":"Saad M. AlBattal","orcid":"https://orcid.org/0009-0008-3252-7567","observed_orcids":["https://orcid.org/0009-0008-3252-7567"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Saad Albattal","raw_affiliation_strings":["Model of Care, Health Holding Company"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Model of Care, Health Holding Company","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5021283377","display_name":"Abdullah M. Alarifi","orcid":"https://orcid.org/0000-0003-4456-074X","observed_orcids":["https://orcid.org/0000-0003-4456-074X"]},"institutions":[{"id":"https://openalex.org/I134359838","display_name":"Alfaisal University","ror":"https://ror.org/00cdrtq48","country_code":"SA","type":"education","lineage":["https://openalex.org/I134359838"]},{"id":"https://openalex.org/I4210103044","display_name":"Ministry of Health","ror":"https://ror.org/01b1c8m98","country_code":"IQ","type":"government","lineage":["https://openalex.org/I4210103044"]}],"countries":["IQ","SA"],"is_corresponding":false,"raw_author_name":"Abdullah M. Alarifi","raw_affiliation_strings":["College of Medicine, Alfaisal University","Deputyship of Population Health, Ministry of Health"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"College of Medicine, Alfaisal University","institution_ids":["https://openalex.org/I134359838"]},{"raw_affiliation_string":"Deputyship of Population Health, Ministry of Health","institution_ids":["https://openalex.org/I4210103044"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5161492343","display_name":"Amal Almughthim","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Amal Almughthim","raw_affiliation_strings":["Model of Care, Health Holding Company"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Model of Care, Health Holding Company","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5043279911","display_name":"Lamis Alghamdi","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Lamis Alghamdi","raw_affiliation_strings":["Model of Care, Health Holding Company"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Model of Care, Health Holding Company","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5108299067","display_name":"Hussam S Alghamdi","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Hussam Alghamdi","raw_affiliation_strings":["Al Baha Health Cluster, Health Holding Company"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Al Baha Health Cluster, Health Holding Company","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5161492314","display_name":"Maryam Almuhib","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Maryam Almuhib","raw_affiliation_strings":["Jazan Health Cluster, Health Holding Company"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Jazan Health Cluster, Health Holding Company","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5161470867","display_name":"Ali Alhamad","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Ali Alhamad","raw_affiliation_strings":["Al Ahsa Health Cluster, Health Holding Company"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Al Ahsa Health Cluster, Health Holding Company","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5161453790","display_name":"Fahad Almutiry","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Fahad Almutiry","raw_affiliation_strings":["Hafar Al-Batin Health Cluster, Health Holding Company"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Hafar Al-Batin Health Cluster, Health Holding Company","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5161426778","display_name":"Dhafer Al Zulayq","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Dhafer Al Zulayq","raw_affiliation_strings":["Najran Health Cluster, Health Holding Company"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Najran Health Cluster, Health Holding Company","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5161455526","display_name":"Nourah Aljowhri","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Nourah Aljowhri","raw_affiliation_strings":["Tabuk Health Cluster, Health Holding Company"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Tabuk Health Cluster, Health Holding Company","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5028934838","display_name":"Alhanouf Aloufi","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Alhanouf Aloufi","raw_affiliation_strings":["Madinah Health Cluster, Health Holding Company"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Madinah Health Cluster, Health Holding Company","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5130520706","display_name":"Najwa Ahmad M Alqurashi","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Najwa Alqurashi","raw_affiliation_strings":["Makkah Health Cluster, Health Holding Company"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Makkah Health Cluster, Health Holding Company","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5161434005","display_name":"Saleh Ali Alsagti","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Saleh Ali Alsagti","raw_affiliation_strings":["Aseer Health Cluster, Health Holding Company"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Aseer Health Cluster, Health Holding Company","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5161435937","display_name":"Mutasim Almuayqil","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Mutasim Almuayqil","raw_affiliation_strings":["Al Jouf Health Cluster, Health Holding Company"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Al Jouf Health Cluster, Health Holding Company","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5125460975","display_name":"Abdullah M. Assiri","orcid":"https://orcid.org/0000-0002-8721-1331","observed_orcids":["https://orcid.org/0000-0002-8721-1331"]},"institutions":[{"id":"https://openalex.org/I4210103044","display_name":"Ministry of Health","ror":"https://ror.org/01b1c8m98","country_code":"IQ","type":"government","lineage":["https://openalex.org/I4210103044"]}],"countries":["IQ"],"is_corresponding":false,"raw_author_name":"Abdullah M. Assiri","raw_affiliation_strings":["Deputyship of Population Health, Ministry of Health"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Deputyship of Population Health, Ministry of Health","institution_ids":["https://openalex.org/I4210103044"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5042438846","display_name":"Najim Zafer Alshahrani","orcid":"https://orcid.org/0000-0002-2163-004X","observed_orcids":["https://orcid.org/0000-0002-2163-004X"]},"institutions":[{"id":"https://openalex.org/I4210099699","display_name":"University of Jeddah","ror":"https://ror.org/015ya8798","country_code":"SA","type":"education","lineage":["https://openalex.org/I4210099699"]}],"countries":["SA"],"is_corresponding":true,"raw_author_name":"Najim Z. Alshahrani","raw_affiliation_strings":["Faculty of Medicine, Department of Family and Community Medicine, University of Jeddah"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Faculty of Medicine, Department of Family and Community Medicine, University of Jeddah","institution_ids":["https://openalex.org/I4210099699"]}]}],"institutions":[],"countries_distinct_count":2,"institutions_distinct_count":3,"corresponding_author_ids":["https://openalex.org/A5042438846"],"corresponding_institution_ids":["https://openalex.org/I4210099699"],"apc_list":{"value":3150,"currency":"CHF","value_usd":3801},"apc_paid":{"value":3150,"currency":"CHF","value_usd":3801},"fwci":0.0,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":{"value":0.0,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"14","issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T14212","display_name":"Health Promotion and Cardiovascular Prevention","score":0.9994999766349792,"subfield":{"id":"https://openalex.org/subfields/2739","display_name":"Public Health, Environmental and Occupational Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T14212","display_name":"Health Promotion and Cardiovascular Prevention","score":0.9994999766349792,"subfield":{"id":"https://openalex.org/subfields/2739","display_name":"Public Health, Environmental and Occupational Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10027","display_name":"Diabetes, Cardiovascular Risks, and Lipoproteins","score":0.00019999999494757503,"subfield":{"id":"https://openalex.org/subfields/2712","display_name":"Endocrinology, Diabetes and Metabolism"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11590","display_name":"Primary Care and Health Outcomes","score":9.999999747378752e-05,"subfield":{"id":"https://openalex.org/subfields/2714","display_name":"Family Practice"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.7792999744415283},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.5218999981880188},{"id":"https://openalex.org/C512399662","wikidata":"https://www.wikidata.org/wiki/Q3505712","display_name":"Family medicine","level":1,"score":0.5020999908447266},{"id":"https://openalex.org/C2908647359","wikidata":"https://www.wikidata.org/wiki/Q2625603","display_name":"Population","level":2,"score":0.4952000081539154},{"id":"https://openalex.org/C2779134260","wikidata":"https://www.wikidata.org/wiki/Q12136","display_name":"Disease","level":2,"score":0.4359999895095825},{"id":"https://openalex.org/C46304622","wikidata":"https://www.wikidata.org/wiki/Q374814","display_name":"Certification","level":2,"score":0.412200003862381},{"id":"https://openalex.org/C116834253","wikidata":"https://www.wikidata.org/wiki/Q2039217","display_name":"Identification (biology)","level":2,"score":0.41029998660087585},{"id":"https://openalex.org/C99454951","wikidata":"https://www.wikidata.org/wiki/Q932068","display_name":"Environmental health","level":1,"score":0.4011000096797943},{"id":"https://openalex.org/C2777180221","wikidata":"https://www.wikidata.org/wiki/Q3025883","display_name":"Type 2 diabetes","level":3,"score":0.3808000087738037},{"id":"https://openalex.org/C22467394","wikidata":"https://www.wikidata.org/wiki/Q849359","display_name":"Multidisciplinary approach","level":2,"score":0.37310001254081726},{"id":"https://openalex.org/C2778149918","wikidata":"https://www.wikidata.org/wiki/Q3291156","display_name":"Population health","level":3,"score":0.3662000000476837},{"id":"https://openalex.org/C143095724","wikidata":"https://www.wikidata.org/wiki/Q515895","display_name":"Odds","level":3,"score":0.3653999865055084},{"id":"https://openalex.org/C511355011","wikidata":"https://www.wikidata.org/wiki/Q12174","display_name":"Obesity","level":2,"score":0.35989999771118164},{"id":"https://openalex.org/C195910791","wikidata":"https://www.wikidata.org/wiki/Q1324077","display_name":"Medical record","level":2,"score":0.35260000824928284},{"id":"https://openalex.org/C2984752397","wikidata":"https://www.wikidata.org/wiki/Q3259956","display_name":"Primary care","level":2,"score":0.34860000014305115},{"id":"https://openalex.org/C12174686","wikidata":"https://www.wikidata.org/wiki/Q1058438","display_name":"Risk assessment","level":2,"score":0.3343999981880188},{"id":"https://openalex.org/C156957248","wikidata":"https://www.wikidata.org/wiki/Q1862216","display_name":"Odds ratio","level":2,"score":0.3197000026702881},{"id":"https://openalex.org/C163432668","wikidata":"https://www.wikidata.org/wiki/Q623543","display_name":"Primary health care","level":3,"score":0.313400000333786},{"id":"https://openalex.org/C27415008","wikidata":"https://www.wikidata.org/wiki/Q7256382","display_name":"Psychological intervention","level":2,"score":0.3118000030517578},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.3116999864578247},{"id":"https://openalex.org/C2982889124","wikidata":"https://www.wikidata.org/wiki/Q107439039","display_name":"Disease management","level":4,"score":0.31029999256134033},{"id":"https://openalex.org/C545542383","wikidata":"https://www.wikidata.org/wiki/Q2751242","display_name":"Medical emergency","level":1,"score":0.3082999885082245},{"id":"https://openalex.org/C142052008","wikidata":"https://www.wikidata.org/wiki/Q954027","display_name":"Cross-sectional study","level":2,"score":0.3075000047683716},{"id":"https://openalex.org/C2779874844","wikidata":"https://www.wikidata.org/wiki/Q1967281","display_name":"National Health and Nutrition Examination Survey","level":3,"score":0.30660000443458557},{"id":"https://openalex.org/C138816342","wikidata":"https://www.wikidata.org/wiki/Q189603","display_name":"Public health","level":2,"score":0.29010000824928284},{"id":"https://openalex.org/C31266012","wikidata":"https://www.wikidata.org/wiki/Q6554340","display_name":"Linkage (software)","level":3,"score":0.2833999991416931},{"id":"https://openalex.org/C2776361769","wikidata":"https://www.wikidata.org/wiki/Q821775","display_name":"Public health surveillance","level":3,"score":0.2827000021934509},{"id":"https://openalex.org/C5395021","wikidata":"https://www.wikidata.org/wiki/Q1061410","display_name":"Program evaluation","level":2,"score":0.2750000059604645},{"id":"https://openalex.org/C74909509","wikidata":"https://www.wikidata.org/wiki/Q10387","display_name":"Gerontology","level":1,"score":0.26809999346733093},{"id":"https://openalex.org/C555293320","wikidata":"https://www.wikidata.org/wiki/Q12206","display_name":"Diabetes mellitus","level":2,"score":0.26339998841285706},{"id":"https://openalex.org/C534262118","wikidata":"https://www.wikidata.org/wiki/Q177719","display_name":"Medical diagnosis","level":2,"score":0.2533999979496002}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.3389/fpubh.2026.1969770","doi":"https://doi.org/10.3389/fpubh.2026.1969770","is_oa":true,"landing_page_url":"https://doi.org/10.3389/fpubh.2026.1969770","pdf_url":"https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2026.1969770/pdf","source":{"id":"https://openalex.org/S2595931848","display_name":"Frontiers in Public Health","issn_l":"2296-2565","issn":["2296-2565"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["anvur-scientific","cwts-core","doaj","medline","norway-1","poland-100","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320527","host_organization_name":"Frontiers Media","host_organization_lineage":["https://openalex.org/P4310320527"],"host_organization_lineage_names":["Frontiers Media"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Frontiers in Public Health","raw_type":"journal-article"}],"best_oa_location":{"id":"doi:10.3389/fpubh.2026.1969770","doi":"https://doi.org/10.3389/fpubh.2026.1969770","is_oa":true,"landing_page_url":"https://doi.org/10.3389/fpubh.2026.1969770","pdf_url":"https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2026.1969770/pdf","source":{"id":"https://openalex.org/S2595931848","display_name":"Frontiers in Public Health","issn_l":"2296-2565","issn":["2296-2565"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["anvur-scientific","cwts-core","doaj","medline","norway-1","poland-100","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320527","host_organization_name":"Frontiers Media","host_organization_lineage":["https://openalex.org/P4310320527"],"host_organization_lineage_names":["Frontiers Media"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Frontiers in Public Health","raw_type":"journal-article"},"sustainable_development_goals":[],"study_designs":[],"awards":[],"funders":[],"has_content":{"pdf":true,"grobid_xml":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7225792970.pdf","grobid_xml":"https://content.openalex.org/works/W7225792970.grobid-xml"},"referenced_works_count":36,"referenced_works":["https://openalex.org/W1984091723","https://openalex.org/W2026696747","https://openalex.org/W2055784512","https://openalex.org/W2095645712","https://openalex.org/W2145555293","https://openalex.org/W2148233314","https://openalex.org/W2167997731","https://openalex.org/W2592673947","https://openalex.org/W2763418014","https://openalex.org/W2765233497","https://openalex.org/W2794355923","https://openalex.org/W2888674369","https://openalex.org/W3001764054","https://openalex.org/W3097431637","https://openalex.org/W3177909485","https://openalex.org/W3201285450","https://openalex.org/W3207011749","https://openalex.org/W4290600022","https://openalex.org/W4294379351","https://openalex.org/W4304203026","https://openalex.org/W4308512200","https://openalex.org/W4323535378","https://openalex.org/W4367599032","https://openalex.org/W4380304108","https://openalex.org/W4382344214","https://openalex.org/W4386098926","https://openalex.org/W4389475884","https://openalex.org/W4401728708","https://openalex.org/W4404370325","https://openalex.org/W4410166771","https://openalex.org/W4411473093","https://openalex.org/W4413348272","https://openalex.org/W4417201071","https://openalex.org/W4417454983","https://openalex.org/W7116785907","https://openalex.org/W7210271204"],"related_works":[],"abstract_inverted_index":{"Background":[0],"Cardiometabolic":[1],"disease":[2,261],"prevention":[3],"requires":[4],"integrated":[5],"approaches":[6],"that":[7,293],"connect":[8],"risk":[9,85,103,297],"identification":[10,298],"with":[11,99,119,193,229],"timely":[12],"confirmation,":[13],"care":[14,206,325],"linkage,":[15,326],"and":[16,48,60,72,101,116,131,167,188,220,255,281,299,323,354],"long-term":[17],"management":[18],"within":[19,250,308],"routine":[20,88],"healthcare.":[21],"Saudi":[22],"Arabia":[23],"developed":[24],"the":[25,27,46,96,107,145,160,171,210,238,309],"Reverse":[26],"Odds":[28],"(RTO)":[29],"program,":[30],"a":[31,164,194,230,251],"national":[32,108,260,305],"electronic":[33],"health":[34,70,136],"record":[35],"(EHR)-enabled":[36],"initiative":[37],"embedded":[38,105],"in":[39,106,144],"primary":[40],"healthcare":[41,89],"(PHC).":[42],"This":[43],"study":[44],"describes":[45,316],"program":[47],"evaluates":[49],"its":[50],"early":[51,61,346],"implementation":[52,62,247,291,347],"using":[53],"routinely":[54],"collected":[55],"aggregate":[56],"data.":[57],"Program":[58],"description":[59],"findings":[63,111],"RTO":[64,290],"was":[65,209,302],"implemented":[66],"through":[67],"all":[68],"20":[69],"clusters":[71],"2,048":[73],"activated":[74],"PHC":[75,165,275,311],"centers.":[76],"The":[77,285,314],"Phase":[78,146],"1":[79,147],"operational":[80,148],"model":[81],"used":[82],"opportunistic":[83],"cardiometabolic":[84,186,240,296],"assessment":[86],"during":[87],"encounters,":[90],"rather":[91],"than":[92],"universal":[93],"screening":[94,155,319],"of":[95,159,170,191,227,237,259,289],"general":[97],"population,":[98,150],"diabetes":[100],"cardiovascular":[102],"tools":[104],"EHR.":[109],"Positive":[110],"triggered":[112],"confirmatory":[113],"assessment,":[114],"referral,":[115],"multidisciplinary":[117],"management,":[118],"eligible":[120],"individuals":[121,228],"entering":[122],"structured":[123],"lifestyle":[124],"and/or":[125],"medical":[126],"pathways.":[127],"Between":[128],"July":[129],"2025":[130],"March":[132],"2026,":[133],"911":[134],"certified":[135],"coaches":[137],"were":[138],"deployed":[139,303],"nationwide.":[140],"Among":[141,176],"632,948":[142],"adults":[143],"target":[149,161,172],"580,941":[151],"(91.8%)":[152],"responded":[153],"to":[154,343],"invitations,":[156],"498,096":[157],"(78.7%":[158],"population)":[162,173],"attended":[163],"visit,":[166,202],"429,209":[168],"(67.8%":[169],"completed":[174,197],"screening.":[175],"screened":[177],"individuals,":[178],"366,445":[179],"(85.4%)":[180],"had":[181,233],"at":[182,198,304],"least":[183,199],"one":[184,200],"positive":[185,195,231],"finding,":[187],"224,007":[189],"(61.1%":[190],"those":[192],"finding)":[196],"follow-up":[201],"here":[203],"termed":[204],"initial":[205,324],"linkage.":[207],"Obesity":[208],"most":[211],"frequently":[212],"detected":[213],"condition,":[214],"followed":[215],"by":[216],"hyperlipidemia,":[217],"hypertension,":[218],"prediabetes,":[219],"previously":[221],"undiagnosed":[222],"type":[223],"2":[224],"diabetes;":[225],"89.8%":[226],"finding":[232],"two":[234],"or":[235,336],"more":[236],"five":[239],"conditions/risk":[241],"states":[242],"assessed.":[243],"These":[244],"figures":[245],"represent":[246],"detection":[248,321],"yield":[249],"selected,":[252],"healthcare-engaged":[253],"population":[254],"are":[256],"not":[257,329],"estimates":[258],"prevalence.":[262],"Implementation":[263],"strategies":[264],"included":[265],"phased":[266],"cluster":[267],"onboarding,":[268],"stakeholder":[269],"engagement,":[270,334],"patient":[271],"outreach,":[272],"EHR-based":[273],"flagging,":[274],"activation,":[276],"workforce":[277],"deployment,":[278],"dashboard":[279],"monitoring,":[280],"workflow":[282,301],"adaptation.":[283],"Conclusions":[284],"first":[286],"9":[287],"months":[288],"show":[292],"an":[294],"EHR-enabled":[295],"care-linkage":[300],"health-system":[306],"scale":[307],"defined":[310],"rollout":[312],"population.":[313],"evaluation":[315,340],"reach,":[317],"adoption,":[318],"completion,":[320],"yield,":[322],"but":[327],"does":[328],"establish":[330],"clinical":[331],"effectiveness,":[332],"sustained":[333],"equity,":[335],"cost":[337],"savings.":[338],"Longitudinal":[339],"is":[341],"required":[342],"determine":[344],"whether":[345],"translates":[348],"into":[349],"durable":[350],"clinical,":[351],"behavioral,":[352],"implementation,":[353],"economic":[355],"outcomes.":[356]},"counts_by_year":[],"updated_date":"2026-11-12T12:28:57.059296","created_date":"2026-11-12T00:00:00"}