LifestyleandWeight Management)Update) · page3 LiVeWell:BeyondOurClinics! •...
Transcript of LifestyleandWeight Management)Update) · page3 LiVeWell:BeyondOurClinics! •...
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Lifestyle and Weight Management Update
© 2013 Intermountain Healthcare. All rights reserved.
Tamara Sheffield, MD, MPH
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Medical Group—Whole Health Integra<on • Personalized Primary Care Clinics • Lifestyle and Weight Management Care Process Model -‐ Adult • Lifestyle and Weight Management Care Process Model -‐ Children and
Adolescents – Currently in Development 2014-‐2015
• Weigh to Health/LiVe Healthy Habits for Kids Weight Management Programs
• Physical Ac@vity as a Vital Sign • Mental Health Integra@on
• Intermountain Preven@ve Care Guidelines • Choosing Wisely • Diabetes Preven@on (Prediabetes CPM)
© 2013 Intermountain Healthcare. All rights reserved.
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LiVeWell: Beyond Our Clinics • Communica@ons: media programs, partnerships and messages • SelectHealth: employer groups and members (Healthy Living)
• Intermountain Human Resources: Incen@ve Program • My Health Assessment, programs and coaching • My Learning Modules • My Choice Ac@vi@es
• Corporate mee@ng guidelines • Community health fair guidelines • Hospitals: Community Benefit ac@vi@es • Pa@ent educa@on
© 2013 Intermountain Healthcare. All rights reserved.
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Lifestyle and Weight Management CPM
• Began with adult weight management CPM; evolved to a broader approach
• Expanded focus on lifestyle with new evidence—and a new approach for a CPM
© 2013 Intermountain Healthcare. All rights reserved.
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Lifestyle and Weight Management CPM • New approach for a CPM: includes WHY and HOW, not just WHAT: • Purpose, principles, and prac@ce • Addressing clinician and pa@ent mo@va@on • Team structure, strategies, and tools for success
• Behavior change techniques and tools
• Levels of adop@on – “Spa Package” • Regional coordina@on of services
© 2013 Intermountain Healthcare. All rights reserved.
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HOW – Team Structure and Elements for Success
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• Roles • Process Coordinator • Pa@ent Coach
• Resources • Processes – based on goal • “Team Huddles” for improvement and coordina@on
• Environment
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Team process planning tools
• Team Process Worksheet: Helps a team define a goal, iden@fy roles, design a workflow process, and coordinate with specialists
• Slide set: Introduces lifestyle management and helps a clinic team use the team process worksheet in a staff mee@ng
© 2013 Intermountain Healthcare. All rights reserved.
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WHY and HOW for pa<ents: behavior change tools
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• Lifestyle and Health Risk QuesDonnaire
• Readiness Ruler • Readiness Worksheet • AcMon Plan • Rx to LiVe Well
CPM has @ps for best approach in 1-‐2 minutes, 2-‐5 minutes, 5-‐10 minutes, or separate lifestyle management appointment (page 11)
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iCentra
• Evalua<ng pa<ent: • Enter data through a pre-‐structured Power Form
• LWM Ques<onnaire: Physical Ac@vity/Nutri@on/Sleep, Mental Health, Social Support/Weight
• STOP-‐BANG sleep apnea screen • Enter data into clinical note
• Use a pre-‐structured Template
© 2013 Intermountain Healthcare. All rights reserved.
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1. On average, how many days a week do you perform physical ac@vity or exercise?
2. On average, how many total minutes of physical ac@vity or exercise do you perform on those days? days/week X minutes/day = min/week (PAVS)
3. Describe the intensity of your physical ac@vity or exercise: light = casual walk moderate = brisk walk vigorous = jogging
Physical Ac<vity Vital Sign in HELP2 iCentra
150
5
30
Light, moderate, vigorous
Start, increase, maintain
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Sedentary behavior • Sedentary behavior <me is an independent predictor of mortality, even for those who have recommended levels of physical acMvity.1
• Taking ac<vity breaks makes a difference. A study of sedentary workers showed that interrup@ng sihng with short bouts of light-‐ to moderate-‐intensity walking reduced postprandial glucose (P<0.01) and insulin (P<0.0001).2
© 2013 Intermountain Healthcare. All rights reserved.
1. van der Ploeg H, et al. Arch Intern Med. 2012; 172(6): 494-‐500.
2. Dunstan DW, et al. Diabetes Care. 2012;35(5):976-‐983.
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Sedentary behavior Recommenda<ons: • Aim for less than 2 hours “screen @me” in addi@on to work/school
• Aim for less than 6 hours total sihng per day, including work/school
• When sihng, take an ac@vity break (2 to 3 minutes) every 30 to 60 minutes
© 2013 Intermountain Healthcare. All rights reserved.
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Resources for physical ac@vity: • LiVe Well, Move More handout with encouragement and informa@on for increasing physical ac@vity
• LiVe Well 1-‐Week Habit Tracker to foster tracking physical ac@vity and other healthy behaviors
• www.exerciseismedicine.org
© 2013 Intermountain Healthcare. All rights reserved.
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Resources for healthy nutri<on: WHAT, HOW and WHY
• LiVe Well, Eat Well handout with encouragement and informa@on for making healthier choices
• LiVe Well Food and Feelings Journal to track hunger, food choices, and emo@ons
• Choose My Plate handouts (25 total), each with 10 easy @ps on healthy food choices, beverage choices, smart shopping, and more
• www.choosemyplate.gov
© 2013 Intermountain Healthcare. All rights reserved.
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Importance of follow-‐up
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Self-‐monitoring: Monitoring tools can help pa@ents track their behavior and progress. Examples include: • Intermountain tools (LiVe Well 1-‐week
Habit Tracker, The Weigh to Health® Habit Tracker)
• Websites and phone apps (SuperTracker, My Fitness Pal, Calorie Tracker, etc.)
• Devices (pedometers, FitBit, etc.)
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Resources for PA, Nutri<on, Sleep, Stress and Social Support, Weight Management: Where Do We Find These Resources?
• Website: • intermountain.net/lifestyle • intermountainphysician.org/lifestyle • Within firewall, just type “lifestyle”
• Ordering from www.i-‐printstore.com: • Browse or sign in • Choose Pa@ent and Provider Educa@on materials
• Menu—Primary Care and Preven@on – Lifestyle
• Or just search for “lifestyle”
© 2013 Intermountain Healthcare. All rights reserved.
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Ge^ng Credit – Where to Go for eCME
Go to intermountainphysician.org, click CME at top lep Choose Intermountain CME from dropdown Choose Online Learning (eCME) from lep side menu hqps://intermountainphysician.org/intermountaincme/Pages/ecme.aspx The module @tle is “Lifestyle and Weight Management CPM” in the Primary Care Sec@on 2 Hours CME credit
© 2013 Intermountain Healthcare. All rights reserved.
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Learning Module: Ge^ng Credit • Read Care Process Model and Review Tools • Complete online CPU (Care Process Update) • View LWM CPM Educa@onal Video
• PPC – Chronic Care Goal (9 sites) • VRP – Community Benefit (Secondary Care) • VRP – Clinical Excellence (Sports Medicine)
• Email Regional Medical Director with • Statement of comple@on • Descrip@on of your plan to use one or more
of the tools in the next 6 months: which pa@ents, which tool(s), how you will record the use of the tools
© 2013 Intermountain Healthcare. All rights reserved.
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Levels of adop<on
© 2013 Intermountain Healthcare. All rights reserved.
• 1 or more clinicians/staff
• Understand the CPM and tools
• Know how to refer to Weigh to Health (W2H)
Level 1a: Knowledge
Level 1b: Limited Use
• 1 or more clinicians/staff
• Understand CPM, tools, and W2H
• Limited use of tools and W2H referrals
• Limited HELP2 data recorded
Level 2: Team Process
• Most clinicians/staff, clinic manager
• Clinic has iden@fied a team process that iden@fies roles and responsibili@es to implement lifestyle/weight management (LM/WM) tools and referrals, using exis@ng resources
• Staff records HELP2 data as appropriate
• Team members have set personal wellness goals
Level 3: Care Coordina<on
• Most clinicians/staff, clinic manager, care manager, health advocate
• Team rou@nely iden@fies at-‐risk pa@ents for LM/WM interven@ons
• Staff members use tools and process to coach and refer pa@ents
• Team coordinates resources
• Staff records HELP2 data and monitors outcomes
• Clinic environment is friendly to WM pa@ents and provides educa@on
PotenDal AdopDon RouDnized Physical AcDvity as a Vital Sign (PAVS)—all clinics, all levels
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How can providers promote “Whole Health” in their pa<ents?
© 2013 Intermountain Healthcare. All rights reserved.
• Read the LWM CPM to review the evidence on primary care interven@ons to promote adequate physical ac@vity, healthy ea@ng, healthy sleep, stress management, and mental health in the context of the individual’s family and environment
• Discuss adop@on strategies based on best prac@ce and available resources
• Develop team process to support pa@ents • Offer resources to support pa@ent’s efforts • Work with PCCP to measure the impact
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Thank you!
© 2013 Intermountain Healthcare. All rights reserved.
QuesMons?