Columbus Neighborhood Health Center Inc. (CNHC) Julie vanPutten, MPH,MS,MD,PHD Mary Fehskens, MD Yami Sahr, MA Buhari Mohammed, MD C.O.A.C.H. Learning.

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  • Columbus Neighborhood Health Center Inc. (CNHC)Julie vanPutten, MPH,MS,MD,PHDMary Fehskens, MDYami Sahr, MABuhari Mohammed, MD

    C.O.A.C.H. Learning Session #2University of ChicagoJune 18 - 19, 2009

  • Overview Weight Loss Program6-week kick-off program:Implemented Fall 2007Target population: CNHC patients with BMI >3012-week group sessions:Every Monday at East Central Clinic Classes are FREE

  • Weight Management ClassJune 8, 2009

  • Review of Weight Loss Program

    Target audience:All CNHC patients with BMI > 30Uncontrolled DM, HTN, LipidsAll patients who want to loose weight (could be BMI >25)

  • Weight Loss Program cont..

    Staff InvolvedProviders, Nurses, Medical Assistants LiteratureFlyers and relevant reading material is available to all patients.Additional awarenessAnnouncements at staff meetings

  • Weight Loss Program cont..

    Structure of the program Weekly weigh-inReview previous week / food logsBiggest loser prize Topic of discussionGet HIP! A healthy incentives programPhysical activity component12 week sessions

  • Case Study 1Sherry55 years old Caucasian femalePresenting withHyperlipidemia DM IIEnrolled on 1/26/09Attended 15 sessions up to date

    1/26/095/18/09Height64 inc64 incWeight249.8lb228.4lbBMI4339.5A1c5.9?LDL137128

  • Case Study 2Sharon62 years old Caucasian femalePresenting with-DM II -HTNEnrolled on 10/6/08Attended 27 sessions to date

    10/6/085/18/09Height59 inc59 incWeight231.6lb216.2lbBMI4744A1c7.87.7BP138/84119/58

  • Case Study 3Pamela46 years old Black femalePresenting with-HTN -newly Dx. DM IIControlling with diet Enrolled on 4/27/09Attended 4 sessions to date

    4/27/095/18/09Height65 inc65 incWeight301 lb294 lbBMI50.549.5

  • Weight Management ClassJune 8, 2009

  • Review of Baseline DataAnalysis for the first year

    Programs Strengths:

    Attendance to program varied initially6 week pilot 4 completed majorityAttendance increased with time averaging 8/classProgram extended to 12 week sessionsImproved retention ~70-90%Improved recruitments ~ 20-40%

  • Review of Baseline Data contAnalysis for the first year Programs weaknesses:

    Recruitment Referral not translating into recruitmentStreamline target ( BMI in charts )Lack of referrals from all Providers Target 25/ Month but having 10/ Month (40%)5 recruitment per month (50%)5 clinics to 1 program

  • Review of Baseline Data cont Analysis for the first year

    Areas for Change: At the beginning of first yearInstitute BMI Measurement systemEstablish a referral systemTrain all medical workers about the program

    Areas of ImprovementStreamline the referral guidelines Increase marketing

  • Review of Baseline Data cont Analysis for the first year

    Goals and objectives

    Establish referral guidelines Relate program impact to patient/clinical goalsReplicate program to other clinics

  • Improvement Strategies Review of first year ProgramRecruitment:Printed materials in all exam roomPost card referral systemOpen schedules in centricityAnnouncements at staff meetingInvolvement of Medical Director

  • Improvement Strategies cont Review of first year Program Retention:

    MotivationBiggest looser drawings Holidays challengesInteractive activities Get HIP

    RemindersPhone call remindersNext week topic post card

  • Improvement Strategies cont.. Review of first year Program Other areas:

    Increase our collaborative activities with other agenciesImprove awareness in the network

  • Intervention Fidelity Implementation change strategies Participants were introduced to the 6 stages of changeObstacles encounteredCompliance varies among participantsFacilitation implementation of the change strategies? The addition of incentives to the program facilitated the easy implementation of change

  • Case Study 4Rose66 year old Black femalePresetting with -HTN-ArthritisEnrolled on 10/6/08Attended 19 sessions

    10/6/085/18/09Height67 inc67 incWeight270 lb272 lbsBMI4243HTN136/83?

  • Outcomes Observed in Year 1

    Recruitment- Successful (~50%)Retention-Very Successful (70-90%)Other (Spread)-Not Successful

  • Current Status

    Current strengths:

    Collaborative activities Incentive programs Interactive nature of programRetentions

  • Current Status cont

    Current weaknesses:

    Staffing

    One program per five Clinics

  • Current Goals Goals and Objectives for Year 2

    Spread

    Increase Recruitment

    Increase Retention

  • Current Goals contHow to reach Year 2 goals, objectives.

    Establish another class at our West Side Clinic

    Increase Collaborations to involve nutritionist from other agencies (Staffing)

  • Outcomes Measurements of outcomes in Year 2

    Increase BMI documentations in chart > 25%

    Increase referrals to = 25 / month ( original goal )

    Increase recruitment to >50% of referred

    Increase or maintain retention at 90%

    Spread to at least one other clinic

  • Lessons Learned What we will do differently in Year 2? And why? Need more creative ideas!Topic for next class (Postcard)

    What we will do the same in Year 2? And why?Maintain the biggest looser programMaintain Get HIP Interactive nature of class

  • Lessons Learned cont Recommendations for other health centers to do: Think about incentives/rewards Collaborate with other agenciesBe creative!

    Recommendation for other health centers NOT to do?Self centeredClose to trying new ideas!

  • Continued Learning Goals To help with further improving our weight management program:

    Motivational interview

    Any new idea

  • Weight Management ClassJune 8, 2009

    ******Topic of Discussions: Setting Yourself Up for Success ( Goal : Establish patient support system for weight management) : Portion Control ( Goal: Participants will decrease their portions by utilizing the plate method and or visual aides): Reading Labels ( Goal: Participants will be able to read a food label to determine the amount of Kcals/Fat/Chol/CHO/Na/Other minerals): Snacking and Dining Out ( Goal: Participants will be able to select healthier snacking and dining options): Focus Your Fruit, Vary Your Veggies( Goal: To increase fruits and vegetables intake to 5-9 per day): Get up, Get Moving (Goal: Increase PA to 3-5days/wk for at least 30 minutes): Emotional Component ( Goal: Recognition of emotional eating versus eating when hungry): Grocery Tours (Goal: Learn how to shop appropriately and looking at label why shopping)*Lost 21.4lb in 16 weeks . Averaging 1.4lb per week. Effect on LDL but no current A1c.*Lost 15.4lb in 28 weeks. Averaging 0.6oz per week. Slow but loosing weight. Improve A1c and BP.*Not enough data to report but a significant weight lost , 7lb in 4 weeks averaging 1.75lb a week**

    Initial attendance in fall 2007 typically 2-5 participants per class ( 6 week sessions)Two 6 weeks pilot sessions 1st Session 2 completed > 90% of program 1 completed > 50% 1 completed 42% of the class2nd Session - 2 completed > 90% 1 completed 75% 1 completed 4/12 1 completed 3/12 1 completed 2/12 2 attended 1xIncrease awareness of program has translated to increase recruitment and retention1st session in 2009 ( January March ) Average attendance is 8 participants- 7 participants completed 100% of program ~ 90% retention2nd session in 2009 ( April June ) Average attendance is 10- In the last several week we have a total of 11 participants with one new enrolment at every class.X XBiggest strength is the involvement of Medical Director

    *

    Patients stage of change ( Pre-contemplation Contemplation - Preparation - Action Maintenance Relapse )Created a process MAP of recruitment which is helping a bit.BMI in chart is an issue Standard medical progress not Documentation of BMIHave posted BMI chart in all the clinic/ rooms / way area/ initially being taken by patients / replacementTarget referrals from all providers was 25 per month. Only a few were able to do currently 10 per month ( 40% of target ) and 5 recruitment / month ( 50% of referred patients )******Some participants show up to socialize. Have been showing up since the start of the program without any weight loss documented.** Total referrals ~ 80 . Total attended at least a session 47. Current trend averaging 10 participants in each session.*****BMI Documentations currently at 10 % - Standard progress note, - Train all MA*Open your doors to collaborate with others in your community***

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