1 The Healthy Weight Learning Collaborative: Using Quality Improvement to Prevent and Treat Obesity in Communities CAPT Sarah Linde-Feucht, MD Chief Public Health Officer Health Resources and Services Administration U.S. Department of Health and Human Services USPHS Scientific and Training Symposium College Park, MD June 20, 2012

2 Objectives 1.Describe the impact of overweight and obesity on community health 2.Demonstrate the use of Quality Improvement to prevent and treat obesity communities 3.Identify sustainable ways to achieve healthy weight in communities

3 HRSA Mission To improve health and achieve health equity through access to quality services, a skilled health workforce and innovative programs.

4 Access and Workforce Nearly 19 million patients are served through more than 8000 HRSA-funded health centers, including 1 in 3 people with incomes below the poverty level. Over 500,000 people living with HIV/AIDS receive services through more than 900 HRSA-funded Ryan White Clinics. Two-thirds are members of minority groups. 34 million women, infants, children, and adolescents benefit from HRSA’s maternal and child health programs. Currently more than 10,000 National Health Service Corps clinicians are working in underserved areas in exchange for loan repayment or scholarships.

5 Access and Workforce Workforce training programs Rural health care Federal organ procurement system Poison Control Centers 340B low-cost drug program

6 Adult Obesity

7 Childhood Obesity

8 Impact Health Economics Policy Safety and security Human Cost

9 Impact One in three children born in 2000 will develop diabetes in his or her life, and among African-American and Latino children, that number is one-in-two. The annual medical costs of an obese person are $1,400 more than someone who’s not obese. Obesity costs $147 billion per year in medical costs and obesity in the workforce costs more than $73 billion each year in lost productivity. As a public policy problem, an overweight employee may face higher health insurance premiums, and the taxpayer may face higher Medicare and Medicaid costs. Our nation’s safety and security is threatened as fewer individuals meet standards to serve as firefighters, police, and in the military. Weight discrimination has increased by 66% over the past decade. Unlike Gender, ethnicity, religion, age, and disability, there are no legal protections against discrimination based on weight.

10 Collaborate for Healthy Weight Congress authorizes the Affordable Care Act NICHQ launches Collaborate for Healthy Weight October 2010-March 2013 July 2010 March 2010 HRSA designs vision of Prevention Center for Healthy Weight

11 National quality improvement initiative Breakthrough Series Approach Multi-sector teams Evidence-based interventions Specifically related to prevention and treatment of obesity in children and families The Healthy Weight Collaborative

12 What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? Aims Measures Changes ActPlan StudyDo The Model for Improvement Testing Cycle

13 The Process of Improvement

14 Healthy Weight Collaborative Project Aims Establish sustainable community-based partnerships consisting of primary care, public health and community sector participants Implement and test selected evidence-based and promising interventions to achieve healthy weight and health equity Phased Approach Phase One: Ten teams, June July 2012 Phase Two: 40+ teams, Dec January 2013

15 Selected Focus Areas Tribal Communities Faith-Based Communities Women’s Health Intergenerational Health Community Health Workers Federally Qualified Health Centers Medically Underserved Areas Rural mHealth

16 Collaborate for Healthy Weight

17 Objectives, Strategies, and Activities OBJECTIVE 1: The HWC Team will establish or strengthen multi-sector community-based partnerships so that the Team is both effective and sustainable STRATEGY 1: Commit to the Healthy Weight Collaborative Aim through the development of a community action plan to improve healthy weight of the target population, and establish the necessary infrastructure to effectively implement the plan ACTIVITY A: Create an action plan to improve healthy weight of the target population ACTIVITY B: Develop and strengthen the Team's capacity to effectively implement the plan

18 OBJECTIVE 2: Teams will provide appropriate, planned and coordinated services tailored to the individual and family across lifespan for the target population STRATEGY 2: Develop a consistent message to promote healthy weight in the target population and disseminate the message where the target population lives, learns, works and plays ACTIVITY A: Adopt a message that reflects the priorities of the community around healthy weight promotion ACTIVITY B: Develop and implement a communication plan to reach the target population

19 OBJECTIVE 2: Teams will provide appropriate, planned and coordinated services tailored to the individual and family across lifespan for the target population STRATEGY 3: Assess current weight status throughout the target population using standardized, evidence-based health assessment protocols ACTIVITY A: Adopt a healthy weight assessment template; adapt it to incorporate community priorities and messaging ACTIVITY B: Develop and implement a plan to complete healthy weight assessments in the target population ACTIVITY C: Redesign clinical care delivery to reliably assess patients for weight status including health behaviors

20 OBJECTIVE 2: …coordinated services to individual and family across lifespan… STRATEGY 4: Use a standardized template for a healthy weight plan that can be personalized to address the needs of individuals within the target population ACTIVITY A: Adopt a healthy weight plan that incorporates the cultural, linguistic and literacy needs of the target population and allows for pertinent individualized goals ACTIVITY B: Create and implement a dissemination plan ACTIVITY C: Redesign clinical care delivery to reliably offer plans that support healthy weight, regardless of current weight status ACTIVITY D: Provide education and activities to support individuals and families to follow their healthy weight plans

21 OBJECTIVE 2: …coordinated services to individual and family across lifespan… STRATEGY 5: Build capacity to meet the needs of the target population utilizing an integrated approach that provides ongoing assessment, prevention activities, treatment and appropriate follow-up of healthy weight ACTIVITY A: Assess gaps in capacity to promote healthy weight assessment, healthy weight plans and prevention activities for the target population ACTIVITY B: Integrate efforts across sectors to meet the demand

22 OBJECTIVE 3: Teams will create community environments that enable healthy eating and active living in the target population STRATEGY 6: Implement strategies for improving the environment to support promotion of healthy weight in the target population ACTIVITY A: Develop and implement one organizational policy to improve physical activity ACTIVITY B: Develop and implement one organizational policy to increase healthy eating ACTIVITY C: Develop an action plan for one public health policy that would improve physical activity or healthy eating

23 Virginia

24 Michigan

25 Collaborative Support Model Healthy Weight Interventions Implementation Guide Change Package Collaborative Support Model Tools/ Methods Measurement Strategy Healthy Weight Resources ILab thyWeight.org thyWeight.org Technology Platform On Demand Learning Library Improvement Advisors (IAs) Expert Faculty HRSA Regional Offices/ Staff Partners NICHQ staff enabled by technology Support Learning EnvironmentContent

26 Collective Impact and Sustainable Change Stanford Social Innovation Review, Winter Common Agenda 2.Shared Measurement Systems 3. Mutually Reinforcing Activities 4.Continuous Communication 5.Backbone Support Organizations

27 Objectives 1.Describe the impact of overweight and obesity on community health 2.Demonstrate the use of Quality Improvement to prevent and treat obesity communities 3.Identify sustainable ways to achieve healthy weight in communities

28 CAPT Sarah Linde-Feucht, MD Chief Public Health Officer Thank you!