The Knowledge Program Data Registry,31 the IRB-approved Center for Functional Medicine Patient Registry, and LivingMatrix (a cloud-based patient information management system) provided the data for this study. Patient demographics and comorbidities were obtained from patients’ electronic health record. Household income was estimated using the median income by Census block, based on the patient’s address. HRQoL was measured using PROMIS Scale v1.2 Global Health (PROMIS GH)32 as previously reported.26 PROMIS GH is scored into PROMIS GPH and GMH summary scores which are reported herein. Summary scores are centred on the 2000 US Census with respect to age, sex, education, and race/ethnicity and transformed to a T-score with a mean of 50 and SD of 10.32 Changes of 5 points or more suggest a minimal clinically important difference.33 34 PROMIS GPH and GMH scores were examined at baseline (initial visit) and 3 months (follow-up visit).

Because patient engagement at baseline could confound the relationship between delivery mode and outcome, we measured readiness to change for each group using a 10-item survey. Willingness to change (seven questions), confidence (one question), household support (one question) and clinical practice support (one question) were assessed. All items included a 5-point Likert scale, which were summed to yield a composite score ranging from 10 to 50.

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