Wellness Connect Managing Obesity in Primary Care Ragan DuBose-Morris, PhD – Director, Office for...

Wellness ConnectManaging Obesity in Primary Care

Ragan DuBose-Morris, PhD – Director, Office for Telehealth Education, South Carolina AHEC, MUSC

Josh Brown, PhD – Director of Clinical Services & Training, MUSC Weight Management Center

Access to Obesity Experts

In 2012, the U.S. Preventative Task Force officially recommended “intensive, multicomponent behavioral interventions” for obese adults.

Shift towards population health standards requires better access to services and care coordination among providers.

Maldistribution of nutrition experts, psychologists, and exercise physiologists across the state creates access issues.

Building on Successful Models MUSC Weight Management Center

Ranked as one of the top 15 medical weight management centers in the U.S.

Evidence-based and multidisciplinary team approach

Lovelace Family Medicine

Implemented by Oscar Lovelace, MD

Practice-based and community-focused approach

South Carolina AHEC

Health professions education

Distance delivery network

Wellness Connect Overview Practice-Based Quality Improvement Project

Goal to include 8 practices over 2 years – will have 9

In order to receive small financial incentive to offset provider time and practice disruption, each practice required to facilitate ~20 patients per year (3 cohorts)

Online Provider Education

Every-other-week telehealth classes for patients with multidisciplinary team at MUSC Weight Management

iPad App for real-time, secure data collection and transmission

Recorded sessions for absent/late starting patients

Participating Practices

Clinical, Educational & Technology Support Team MUSC Weight Management Center

Josh Brown, PhD - Psychologist

Tonya Turner, MPH, RD, LD – Registered Dietitian

David Sword, PT, DPT, CCS – Exercise Physiologist

Patrick O’Neil, PhD – Psychologist and Director

Office for Telehealth Education, SC AHEC/MUSC

Ragan DuBose-Morris, PhD - Director

Ali McMenamin, MA - Coordinator

Duncan McDuffie, BS – Program Assistant

Technology Applications Center for Healthful Lifestyles – MUSC CON

Sachin Patel, MSc - Director

Shawntel Parker, BS - Systems Architect

Frank Treiber, PhD - Endowed Chair

Preceptor & Staff Training

MUSC Weight Management – Online Course for Providers

All personnel

Pre-training assessment

Brief video learning modules (100 minutes; ~10 mins/each)

100% practice participation rate

Sample Topic Areas:

Medical Complications of Obesity

Psychosocial Aspects of Obesity

Physical Assessment of Obese Patients

“Bedside Manner” with Obese Patients

Telehealth Technologies

Cisco SX 10 Codec Camera & Monitor

iPad – TACHL App

Weight Scale

BP Cuff (M/L)

Tape Measure

Launching A New Initiative

Practice Identification

Preceptor/Residency Criteria

Identified Area of Need for Nutrition Services

Broadband Assessment

Equipment Purchase and Installation

App Development

Provider Training

Continuous Feedback Loop

App Data Collection & Review

Results - General

Program “Completion”

1. Attending half of possible classes AND

2. Attending at least one class at/beyond 70% mark

No baseline differences in Weight or BMI between eventual completers and non-completers

No difference in completion rate between clinics

Significant difference in Completion Rate between cohorts, c2(1, N = 53) = 7.43, p = .006 Cohort 1 Completion Rate = 88%

Cohort 2 Completion Rate = 53.6%

Results from Cohort 1

•Time: p < 0.001•Clinic: NS•Time*Clinic: NS

Avg Wt Loss: 5.1kg (4.2%)

Expansion for Cohorts 2-3

Revised Data Collection App and Peripherals

Added Additional Geographic Locations

Included Community Health Centers

Spinoff of Physician to New Practice Location

Sustainability Goals - Working Towards Reimbursement from Third-Party Payers

Results from Cohort 2

•Time: p < 0.001•Clinic: NS•Time*Clinic: NS

Avg Wt Loss: 4.6kg (4.5%)

What we’ve learned (so far)

… Patients were satisfied with telehealth weight

management care (93% would recommend to others)

Standard procedures for patient management are important for maintaining patient engagement (e.g., class reminders, PCP check-in)

Minimal technology issues

App development is an ongoing process

Weight loss results comparable to in-person classes

Remaining Challenges

Payer Parity/Reimbursement Medicare

Medicaid

BlueCross/Blue Shield

Patient Engagement for Entire Program

Faculty Provider Time for Expansion

Contact Us for Additional Information

Ragan DuBose-Morris, PhDDirector, Office for Telehealth Education, South Carolina AHEC, MUSC: www.scahec.net/schoolsduboser@musc.edu

Josh Brown, PhDDirector of Clinical Services, MUSC Weight Management: www.MUSChealth.org/weight browjosh@musc.edu