Reducing Obesity with Improved Self-Management Support

UNITE HERE Health Center
New York, New York, USA

Team
The UNITE HERE Health Center team is a participant in the New Health Partnerships initiative.
 
Audrey Lum, RN, MPA, Team Sponsor
Heidi Francis, MD, Clinical Champion
Molly Collins, MD, Associate Medical Director, Clinical Champion
Julie Kaye, RD, MPH, Self-Management Support Trainer
Teresa Galicia, PT, Team Leader
Hong Ying Lin (Vicky), PCA, Team Member
Ana Gonzalez, PCA, Team Member
Carmen Calderon, PSS, Team Member
Kyra Selwyn, Project Support Coordinator, Data Entry
Rose-Magallie Maitre, Patient Advisor
Laura Mills, Patient Advisor


Aim

To reduce obesity by improving self-management for patients with body mass index (BMI) greater than or equal to 30. 

 
We believe that if the care team can track the patient through a registry, while providing the right support, and patients have improved self-efficacy they will be able to reduce their BMI.
 
Specific goals:  
  • Increase reports of behavioral change by 50 percent
  • Increase collaborative goal-setting by 50 percent
  • Increase patient’s reports of specific kinds of support to aid in self-management by 50 percent
  • Increase patient satisfaction to  at least 80 percent

 

Measures

  • Percent of patients who strongly agree that they have made a behavioral change
  • Percent of patients who strongly agree that they were involved in collaborative goal-setting
  • Percent of patient who strongly agree that their health care provider explained things in a way that was easy to understand
  • Percent of patient who strongly agree that they engaged in problem solving with the provider about reaching goals
  • Percent of patients who strongly agree that they are satisfied with the help they received for managing their medical problem
  • Percent of patients who strongly agree that their health care provider asked about beliefs, ideas, and what patient wanted when planning care
  • Percent of patients with body mass index (BMI) of 30 or greater [NOTE: BMI, as calculated by weight and waist measurement, are not included as the team continues to collect the data.]


Changes

UNITE HERE Health Center is a state-of-the art, fully equipped and accredited primary and specialty care center in New York City that treats low-wage, immigrant workers in the garment, hotel, restaurant and laundry industries. The health center redesigned care for patients with obesity by promoting self-management support as the foundation of the patient care plan. We created patient registries for two of ten primary care providers, which allowed us to track changes in BMI over time and patients’ confidence in self-management as measures of improvement. The team then decided to spread the use of self-management support for patients to address chronic conditions within the medical home.

 
  • Developed a self-management support curriculum to train all staff in self-management
  • Created a template in the electronic medical record (EMR) to document self-management goals
  • Collaborative goal-setting:
    • Created a self-management support pamphlet to explain to patients the concept of self-management
    • Nutritionist took on the role of care manager and spearheaded self-management support for the health center
    • Health coaches and other clinical staff began to promote goal-setting
  • Information sharing, problem solving, and values and preferences:
    • Team members tested new self-management skills in their practice with patients using the PDSA method
  • Tested both the ask-tell-ask technique for information sharing, and the Teach Back method (ask patient about their understanding of information)
  • Spread self-management support to a laundry shop whose union employees are patients at the care center
  • Engaged the support of leadership at every step
    • Team coach/consultant improved communication among team members
    • Protected time for meetings and trainings


Results
Graph_UniteHere_DimensionsOfSelfManagementSupport.jpg

Summary of Results / Lessons Learned / Next Steps

While the patient satisfaction measurement has not shown the same rate of improvement as the other measures, the overall trend in patient satisfaction appears to be positive. The graphs above show reports of positive behavior change among the patients, which seems related to improved self-management support. Also shown are patient reports of key aspects of self-management support: participation in collaborative goal-setting, provider recognition of values and preferences, problem solving, and information sharing. Patient satisfaction with care in the medical home also shows improvement.

 
Lesson Learned:
Regarding Care of the Patient
  • Link health coach visits with primary care physician visits to decrease the no-show rate
  • Tailor planned care visits to fit the needs of patients
  • Scheduled telephone visits are an effective follow-up method
  • Use a template to document goals with all self-management patient encounters
 
Regarding Improvement Efforts
  • Leadership support was key to the success of the team
  • Team coach/consultant facilitated use of self-management skills at improvement team meetings. We learned to set goals for the team, to listen to others with respect, and to appreciate our different values. As a result it became natural for staff to use these skills with patients.
  • Testing important concepts with PDSA cycles allowed us to use our time more efficiently
  • Start with early adopters when creating a team and spreading self-management support
  • The benefits of securing the wider staff’s acceptance and support of a new practice paradigm
  • Having outcome measures that reflect our progress
  • An involved and committed patient advisor is invaluable
  • The importance of spread team to incorporate and sustain best practices
 
Barriers:
  • High no-show rates to nutritionist and health coach appointments, presumed secondary to patients’ perceptions that obesity is not an important medical problem (ameliorated with reminder calls)
  • Not all eligible patients have been referred yet to health coach for self-management support
  • Outcome measures for obesity require a long tracking period
  • Limited time to practice skills learned through self-management support training
 
Next Steps: 
  • Continuation of self-management support training of all remaining and new staff, and the spread of self-management support within the medical home (training will include self-management support practice time and competency evaluations)
  • Continue to monitor patient surveys as we spread self-management to other providers and expand the use of health coaches in the health center
  • Standardized weight measurement will become  a vital sign in primary care and we will add weight measurement to patients’ registries
  • Develop patient educational materials and a staff training curriculum for weight management
  • Spread use of self-management template to all health providers
  • Continue self-management support outreach to union shops
  • Celebrate the success of our patients who have learned to use self-management support to improve their chronic conditions (their achievements will be displayed on a large bulletin board at the entrance of the health center)
  • Incorporate the patient advisor role into other teams at the health center

 

Contact Information
Teresa Galicia, PT
UNITE HERE Health Center
tgalicia@unitehere.org

 

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