1. Aiming Higher…Because Fitness is Always Good Medicine ! Making fitness the treatment of choice for prevention and management of many chronic conditions J.A. McAndrews, MPH, Public Health Program Manager Andrew Pasternak, MD, MS Conference on Practice Improvement 2011

2. AIM-HI is: A multi-faceted initiative that includes: –Research/practice improvement –Clinician education and resources –Consumer education –Community advocacy A new approach to prevention and management of chronic conditions

3. AIM-HI Mission: Americans In Motion – Healthy Interventions (AIM-HI) is an AAFP initiative designed to improve the health of all Americans by implementing a multifaceted fitness program addressing physical activity, nutrition and emotional well-being in the individual, family and community.

4. AIM-HI Goals  Encourage family physicians to be fitness role models  Improve family physicians' ability to positively affect the fitness of their patients  Enhance the awareness of family physicians' unique ability to promote fitness within their communities

5. AIM-HI Works! Family physicians are well-positioned to improve the health of patients who are overweight and obese. Because they see millions of patients each year, even small successes in treatment of these diseases are likely to have far-reaching effects. “AIM-HI has revolutionized the way I practice. I now consider changes in fitness-related behaviors to be a first-line treatment for the majority of chronic diseases." Chester Fox, MD Jefferson Family Medicine Buffalo, NY

6. AIM-HI is  Completely funded by educational grants provided by core supporters  Includes key educational partnerships with several national organizations

7. AIM-HI Research Study

8. A 3-year AAFP research study - 1.Developed culturally appropriate patient education materials to support office-based counseling on behavioral change for physical activity, healthy eating and emotional well-being. 2.Developed an evidence-based educational/implementation program to improve delivery of effective patient- centered lifestyle counseling during routine office visits.

9. 3.Evaluated the impact of an evidence-based educational/implementation program using a randomized controlled trial. 4.Evaluated the effects of encouraging clinicians and office staff to personally use tools and how this affects the delivery of intervention to patients. 5.Evaluated the effectiveness of the intervention on (both primary and secondary) patient level behavior change and additional physiologic measures of increased exercise and improved diet.

10. AIM-HI Adapts office environment and practice processes to promote fitness Promotes shift from advice-giving to patient-centered lifestyle counseling Integrates AIM-HI into office routines

11. Silver Sage Center for Family Medicine Independent FP clinic in Reno, NV 2 physicians, 3 medical assistants, 2.5 front office staff Most suburban practice “Side” sports medicine facilities Both physicians were physically active. Staff however…..

12. Our experience with AIM-HI study Became involved because of the topic Biggest surprise is how many people wanted to be involved Patients are looking to their primary care physicians for help Re-emphasized concepts of Motivation Interviewing for providers

13. Our experience with AIM-HI (part 2) Got us more involved in community health Staff that is still around has continued to be active Approach didn’t work for every patient but helped many

14. Preliminary study results –Improvements in self-reported eating behaviors* 41.8% increase in number of patients who reported at least a half serving more in healthy foods per week from baseline to 10 months. 44.8% increase in number of patients who reported at least a half serving less of unhealthy foods per week from baseline to 10 months. – Increase in Self-reported Physical Activity* 10% increase in number of patients who reported physical activity at least 20 min/day, 3 days/week from baseline to 4 months. 10.1% increase in number of patients who reported physical activity at least 20 min/day, 3 days/week from baseline to 10 months. – Improvements in total body weight* 11.8% of patients lost ≥ 10 lbs from baseline to 4 months. 17.8% of patients lost ≥ 10 lbs from baseline to 10 months. *Data from patients who completed 10 month research visits

15. AIM-HI at the clinic… “AIM-HI means to take care of yourself. AIM-HI does not necessarily mean you have to lose weight to feel better. Healthy choices make you feel better.” Cynthia Yates Martin, RN Case Manager, OB Nurse Educator Family Care Health Center St. Louis, MO

16. Online CME Overcoming Barriers to Better Fitness AIM to Change: Encouraging Fitness for All Healthy Steps to Treating Childhood Obesity Foods That Foster Healthy Hearts Patient Centered Approaches to Better Fitness Motivating Healthy Behaviors Putting Nutrition Science to Work in Family Medicine

17. Office Tools AIM-HI Practice Manual AIM-HI Group Visits Guide AIM-HI to Change Toolkit Tips for Healthy Children & Families Poster Pack

18. Patient Education AIM-HI Fitness Inventory AIM-HI Fitness Prescription AIM-HI to Change Food & Activity Journal AIM-HI to Change Health Guides Information on familydoctor.org Resources available in Spanish

19. AIM-HI Fitness Inventory

20. AIM-HI Fitness Prescription

22. AIM-HI Food & Activity Journal

24. Opportunity to Practice Break into two person teams and review all three core tools. Discuss how you feel you could implement these tools in your practice. Share how you would implement one or more of these tools into a patient conversation.

25. Practice Cont. Using the laminated cards, practice opening a patient- centered conversation and introduce one tool to the patient. Switch and allow your partner to practice.

26. Think-Pair-Share-Full Group How well do you feel the tools can be incorporated into your practice? How confident are you that you are able to include at least one tool in your conversation during a brief visit? What did you experience when you practiced using the tool(s)?

27. AIM-HI Works! “A year and a half ago my doctor told me I had congestive heart failure. I was 35. My daughter was 7 years old. I thought, “If I don’t change my eating habits and get off the couch, she won’t have a mother.” I started walking after work… I have lost 20 pounds and my progress has been an incentive for others to make wise choices for a healthy lifestyle. I am no longer on heart medication.” Wanda Harris Front Office Supervisor Berkeley Family Practice Moncks Corner, SC

28. COMMUNITY ADVOCACY

29. Ready, Set, FIT! A school-based program that teaches third and fourth graders about the importance of fitness: physical activity, nutrition and emotional well-being Builds on language arts, math and health skills

30. Ready, Set, FIT! Created by: –AAFP AIM-HI initiative –Scholastic, world's largest publisher and distributor of children's books Endorsed by the National School Boards Association

31. Resources to address childhood obesity Encourage parents and children to talk to their family physician about fitness –“F is for Fitness” book series (4 total books) –“Make a Change for Family Fitness” waiting room DVD

33. “How exciting it is to be working with the patients and seeing them get so motivated when they meet a goal. You share in their achievements and get ideas to relay to your other patients. With AIM-HI, the patients have a sense that their doctor/office staff really care about them. “ AIM-HI Works! Pam Mathis, RN and Wanda Dolby Blue Ridge Family Physicians, Raleigh, NC

34. AIM-HI for the FUTURE! www.americansinmotion.org