Wyoming County Nurse Wellness Coach Program Evaluation

1
Wyoming County Nurse Wellness Coach Program
Evaluation

• Wyoming County Department of Mental Health
• Stephen Snell, LCSW
• Wyoming County Mental Health Clinic
• Joyce Barker, RN
• Well-Balanced Program, University of Rochester,
  Consultants
• Eva Bellis, RN, BSN, CCM
• Donna Tortoretti, RNC, MS, CMAC
• Patricia Lindley, PhD, RN

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Program Design 2006

• Embedded nurse wellness coach (clinic employee)
  works in tandem with mental health clinicians and
  care coordinators on client-determined physical
  health issues
• Caseload 20 slots, revolving enrollment, attends
  SPOA
• Not time limited pace/frequency of contacts vary
• Eligibility Care coordination enrollees with
  moderate to high risk physical health problems,
  by referral
• Program dovetails with Monroes Well Balanced
  Program, using same assessment, documentation and
  planning tools
• Not disease-specific interventions customized to
  individual health problems, client wishes,
  capacities and readiness
• Maximize internet, disease-management protocols
  best practices for education

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Assessment and Enrollment

• Client interview
• Comprehensive Health Risk Assessment (HRA) yields
  numerical score and suggested areas for
  intervention (see sample)
• Home visit
• Laboratory

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2006 Client Participation 20 client caseload
Referred and Assessed Total N32

• Did not enroll n 6
• 3/6 completed HRA

• Dropped Out n 7
• Decided to pursue on own 1
• Moved out of county 2
• To nursing home 1
• Client chose not to pursue 3

Enrolled, completed HRA, bloodwork and
individualized plan N26
Completed Pre-to- Post Analysis N15
10 direct contacts plus all tests and information
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Client Demographics
6
Client Demographics
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Client Demographics
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Client Demographics
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Client Psychiatric Diagnoses Axis I
Wyoming County N 15 n Monroe County N 77 n
Substance Abuse 1 7 51 66
Episodic Mood Disorders Depressive Disorder NOS 7 47 4 27 38 49
Schizophrenic Disorders 4 27 38 49
Anxiety, Dissociative, Somatoform Disorders 1 7 9 12
Stress Disorder 1 7 3 4
Anorexia, Hyperkinetic Disorder, Non-Organic Psychosis 2 14 1 1
adds to gt 100 clients may have more than 1
diagnosis
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Client Psychiatric Diagnoses Axis II
Diagnosis Wyoming County N 15 n Monroe County N 77 n
Personality Disorder 2 13 18 23
Mental Retardation 4 5
Borderline Intellectual Functioning 1 7 3 4
Obsessive-Compulsive Disorder 3 3
Developmental Delay (Reading) 2 3
Post-Traumatic Stress Disorder 1 1
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Client Medical Diagnoses Axis III Wyoming
County N 15
adds to gt 100 clients may have more than 1
diagnosis
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Health Status Wyoming County
13
Health Status Wyoming County N 15
14
Consumer Health Status Wyoming County N 15
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Health Status Wyoming County
16
Health Status Wyoming County
17
Health Status Wyoming County N 15
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Contacts LocationsWyoming County N 15
Total Contacts 222
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Nursing Interventions Health GoalsWyoming
County N 15
Total Health Interventions 346
Behavior, communication, relationships,
development
Function of life sustaining processes
Maintain and promote wellness, recovery, and/or
rehabilitation
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Direct Indirect Contact Times Wyoming County
N 15
Note. Mean is average mode is most frequent.
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Client Service Utilization Wyoming County N 15
Service Use Before Program During Program
Psychiatric Inpatient Hospitalizations 3 (n 14) 4 (n 15)
Medical Inpatient Hospitalizations 2 (n 11) 2 (n 11)
Psychiatric Emergency Room Visits 0 (n 3) 0 (n 3)
Medical Emergency Room Visits 4 (n 12) 7 (n 12)
Note Pre-program data may be less reliable
because it is recall data.
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Consumer Health Status Wyoming County N 15
Entering 1.25 packs/20 years (average)Completing
0.78 packs1 Quit 4 months, 4 reduced gt1/2 ppd
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Higher the score, lower the risk
Consumer Health Status Wyoming County N 15
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Consumer Satisfaction Wyoming County N 15
Rating 1 4 (1 lowest to 4 highest)
1 Quality Service 2 Got Service
3 Met Goals 4 Recommend 5
Satisfied Help 6 Helped Problems 7
Satisfied Overall 8 Come Back
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Client Goals Recommended and Selected

• HRA Recommended Goals Client Selected Goals
• Blood Pressure 3 2
• Exercise 10 7
• Cholesterol 7 5
• Mammogram 2 0
• Smoking 10 6
• Weight 10 8

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Wellness Areas of Change

• SOCIALIZATION
• Two clients began attending Social Club
  regularly.
• DIABETES MANAGEMENT
• Two clients with diabetes who were not testing
  or using insulin began testing regularly and
  using insulin regularly
• Three clients with diabetes who had not attended
  medical appointments began seeing their physical
  care provider.

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Wellness Areas of Change (contd)

• NUTRITION
• - Eight clients made significant improvements in
  their diets, such as eating more fruits and
  vegetables, increasing low fat dairy products and
  lean meats, and decreasing sweets.
• - Three clients met with a dietitian for
  additional help in improving their diets.
• EXERCISE
• - Eight clients increased their level of
  exercise by walking more or riding a bicycle more.

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Wellness Areas of Change (contd)

• MEDICAL CARE
• -Five clients were accompanied to medical care
  appointments resulting in improved communication
  with the provider, and additional diagnostic
  testing and treatment options.
• -Three clients medical care was adjusted based
  on information provided by the Nurse Wellness
  Coach

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Other findings and lessons learned

• Wellness coach P-C approach reduces client
  wariness of nurse involvement
• Obtaining laboratory data is often difficult and
  time-consuming
• HRA is a very useful tool for client, nurse and
  program gives useful patient-friendly
  information key to starting change behaviors,
  tracks progress, encourages positive lifestyle
  shifts, provides aggregate data
• Interventions must be adjusted to client
  situation, considering current mental status,
  learning styles, literacy
• Time, patience relationship-building often
  required changes often start slowly, build on
  earlier steps individual readiness often
  surprises
• Individual support usually most effective formal
  disease management protocols, written materials
  often minimally effective many take well to
  charting progress (e.g. weight or exercise
  charts) especially if gains are being made
• Medical practitioners build confidence in nurse
  over time, welcome help from useful data (lab,
  etc.), better follow-up, enhanced client
  education and support improves medical attention
  to health problems
• Health assessment and referral are required,
  Medicaid-reimbursable services under 14 NYCRR
  Parts 587 and 588