Columbus Neighborhood Health Center Inc. (CNHC)

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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 Session 2 University of
Chicago June 18 - 19, 2009
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Overview

• Weight Loss Program
• 6-week kick-off program
• Implemented Fall 2007
• Target population
• CNHC patients with BMI gt30
• 12-week group sessions
• Every Monday at East Central Clinic
• Classes are FREE

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Weight Management ClassJune 8, 2009
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Review of Weight Loss Program

• Target audience
• All CNHC patients with BMI gt 30
• Uncontrolled DM, HTN, Lipids
• All patients who want to loose weight
• (could be BMI gt25)

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Weight Loss Program cont..

• Staff Involved
• Providers, Nurses, Medical Assistants
• Literature
• Flyers and relevant reading material is available
  to all patients.
• Additional awareness
• Announcements at staff meetings

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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

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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
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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
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Case Study 3

• Pamela
• 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
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Weight Management ClassJune 8, 2009
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Review of Baseline DataAnalysis for the first
year

• Programs 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

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Review of Baseline Data contAnalysis for the
first year

• Programs 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

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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

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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

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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

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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

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Improvement Strategies cont.. Review of first
year Program

• Other areas
• Increase our collaborative activities with other
  agencies
• Improve awareness in the network

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Intervention Fidelity

• Implementation change strategies
• Participants were introduced to the 6 stages of
  change
• Obstacles encountered
• Compliance varies among participants
• Facilitation implementation of the change
  strategies?
• The addition of incentives to the program
  facilitated the easy implementation of change

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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 ?
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Outcomes Observed in Year 1

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

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Current Status

• Current strengths
• Collaborative activities
• Incentive programs
• Interactive nature of program
• Retentions

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Current Status cont

• Current weaknesses
• Staffing
• One program per five Clinics

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Current Goals

• Goals and Objectives for Year 2
• Spread
• Increase Recruitment
• Increase Retention

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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)

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Outcomes

• Measurements of outcomes in Year 2
• Increase BMI documentations in chart gt 25
• Increase referrals to 25 / month ( original
  goal )
• Increase recruitment to gt50 of referred
• Increase or maintain retention at 90
• Spread to at least one other clinic

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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

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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!

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Continued Learning Goals

• To help with further improving our weight
  management program
• Motivational interview
• Any new idea

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Weight Management ClassJune 8, 2009