Transcript
Page 1: 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

Columbus Neighborhood Health Center Inc. (CNHC)

Julie vanPutten, MPH,MS,MD,PHDMary Fehskens, MD

Yami Sahr, MABuhari Mohammed, MD

C.O.A.C.H. Learning Session #2

University of Chicago

June 18 - 19, 2009

Page 2: 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

Overview

Weight Loss Program

• 6-week kick-off program:Implemented Fall 2007

• Target population: CNHC patients with BMI >30

• 12-week group sessions:Every Monday at East Central Clinic

• Classes are FREE

Page 3: 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

Weight Management ClassJune 8, 2009

Page 4: 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

Review of Weight Loss Program

Target audience:

• All CNHC patients with BMI > 30

• Uncontrolled DM, HTN, Lipids

• All patients who want to loose weight (could be BMI >25)

Page 5: 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

Weight Loss Program cont..

• Staff InvolvedProviders, Nurses, Medical Assistants

• LiteratureFlyers and relevant reading material is available to all

patients.

• Additional awarenessAnnouncements at staff meetings

Page 6: 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

Weight Loss Program cont..

Structure of the program

– Weekly weigh-in– Review previous week / food logs– Biggest loser prize – Topic of discussion

– Get HIP!® A healthy incentives program– Physical activity component– 12 week sessions

Page 7: 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

Case Study 1

Sherry• 55 years old

Caucasian female• Presenting with

– Hyperlipidemia – DM II

• Enrolled on 1/26/09• Attended 15 sessions

up to date

1/26/09 5/18/09

Height 64 inc 64 inc

Weight 249.8lb 228.4lb

BMI 43 39.5

A1c 5.9 ?

LDL 137 128

Page 8: 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

Case Study 2

Sharon• 62 years old

Caucasian female• Presenting with

-DM II

-HTN

• Enrolled on 10/6/08• Attended 27 sessions

to date

10/6/08 5/18/09

Height 59 inc 59 inc

Weight 231.6lb 216.2lb

BMI 47 44

A1c 7.8 7.7

BP 138/84 119/58

Page 9: 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

Case Study 3Pamela• 46 years old Black

female• Presenting with

-HTN

-newly Dx. DM II

• Controlling with diet • Enrolled on 4/27/09• Attended 4 sessions

to date

4/27/09 5/18/09

Height 65 inc 65 inc

Weight 301 lb 294 lb

BMI 50.5 49.5

Page 10: 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

Weight Management ClassJune 8, 2009

Page 11: 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

Review of Baseline DataAnalysis for the first year

Program’s Strengths:

– Attendance to program varied initially– 6 week pilot – 4 completed majority– Attendance increased with time averaging

8/class– Program extended to 12 week sessions– Improved retention ~70-90%– Improved recruitments ~ 20-40%

Page 12: 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

Review of Baseline Data cont…Analysis for the first year

Program’s weaknesses:

– Recruitment • Referral not translating into recruitment• Streamline 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

Page 13: 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

Review of Baseline Data cont… Analysis for the first year

Areas for Change: At the beginning of first year

– Institute BMI Measurement system– Establish a referral system– Train all medical workers about the program

Areas of Improvement– Streamline the referral guidelines – Increase marketing

Page 14: 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

Review of Baseline Data cont… Analysis for the first year

Goals and objectives

– Establish referral guidelines – Relate program impact to patient/clinical

goals– Replicate program to other clinics

Page 15: 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

Improvement Strategies Review of first year Program

Recruitment:– Printed materials in all exam room– Post card referral system– Open schedules in centricity– Announcements at staff meeting– Involvement of Medical Director

Page 16: 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

Improvement Strategies cont…

Review of first year Program

Retention:

Motivation– Biggest looser drawings – Holidays challenges– Interactive activities – Get HIP

Reminders– Phone call reminders– Next week topic post card

Page 17: 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

Improvement Strategies cont.. Review of first year Program

Other areas:

– Increase our collaborative activities with other agencies

– Improve awareness in the network

Page 18: 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

Intervention Fidelity

• Implementation change strategies Participants were introduced to the 6 stages of change

• Obstacles encounteredCompliance varies among participants

• Facilitation implementation of the change strategies? The addition of incentives to the program facilitated the

easy implementation of change

Page 19: 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

Case Study 4

Rose

• 66 year old Black female

• Presetting with

-HTN

-Arthritis• Enrolled on 10/6/08• Attended 19 sessions

10/6/08 5/18/09

Height 67 inc 67 inc

Weight 270 lb 272 lbs

BMI 42 43

HTN 136/83 ?

Page 20: 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

Outcomes Observed in Year 1

• Recruitment- Successful (~50%)

• Retention-Very Successful (70-90%)

• Other (Spread)

-Not Successful

Page 21: 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

Current Status

Current strengths:

• Collaborative activities

• Incentive programs

• Interactive nature of program

• Retentions

Page 22: 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

Current Status cont…

Current weaknesses:

• Staffing

• One program per five Clinics

Page 23: 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

Current Goals

Goals and Objectives for Year 2

• Spread

• Increase Recruitment

• Increase Retention

Page 24: 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

Current Goals cont…

How to reach Year 2 goals, objectives.

• Establish another class at our West Side Clinic

• Increase Collaborations to involve nutritionist from other agencies (Staffing)

Page 25: 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

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

Page 26: 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

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 program• Maintain Get HIP • Interactive nature of class

Page 27: 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

Lessons Learned cont…

Recommendations for other health centers to do: • Think about incentives/rewards • Collaborate with other agencies• Be creative!

Recommendation for other health centers NOT to do?• Self centered• Close to trying new ideas!

Page 28: 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

Continued Learning Goals

To help with further improving our weight management program:

• Motivational interview

• Any new idea

Page 29: 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

Weight Management ClassJune 8, 2009


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