LifestyleandWeight Management)Update) · page3 LiVeWell:BeyondOurClinics! • Communicaons:,mediaprograms,,partnerships,and,messages, • SelectHealth:,employer,groups,and,members,(Healthy,Living),

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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)


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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


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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


page 5 © 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


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HOW – Team Structure and Elements for Success


•  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


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WHY and HOW for pa<ents: behavior change tools


•  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


page 11 © 2013 Intermountain Healthcare. All rights reserved.

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


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


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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


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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


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Importance of follow-‐up


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”


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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


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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


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Levels of adop<on


•  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?


•  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!


QuesMons?

Documents

LifestyleandWeight Management)Update) · page3 LiVeWell:BeyondOurClinics! • Communicaons:,mediaprograms,,partnerships,and,messages, • SelectHealth:,employer,groups,and,members,(Healthy,Living),