1. 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

2. Overview Weight Loss Program 6-week kick-off program: Implemented Fall 2007 Target population: CNHC patients with BMI >30 12-week group sessions: Every Monday at East Central Clinic Classes are FREE

3. Weight Management Class June 8, 2009

4. Review of Weight Loss Program Target audience: All CNHC patients with BMI > 30 Uncontrolled DM, HTN, Lipids All patients who want to loose weight (could be BMI >25)

5. 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

6. 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

7. 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 1/26/095/18/09 Height64 inc Weight249.8lb228.4lb BMI4339.5 A1c5.9? LDL137128

8. Case Study 2 Sharon 62 years old Caucasian female Presenting with - DM II - HTN Enrolled on 10/6/08 Attended 27 sessions to date 10/6/085/18/09 Height59 inc Weight231.6lb216.2lb BMI4744 A1c7.87.7 BP138/84119/58

9. 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 4/27/095/18/09 Height65 inc Weight301 lb294 lb BMI50.549.5

10. Weight Management Class June 8, 2009

11. Review of Baseline Data Analysis for the first year Program’s 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%

12. Review of Baseline Data cont … Analysis for the first year Program’s 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

13. 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

14. 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

15. 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

16. 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

17. Improvement Strategies cont.. Review of first year Program Other areas: –Increase our collaborative activities with other agencies –Improve awareness in the network

18. 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

19. Case Study 4 Rose 66 year old Black female Presetting with -HTN -Arthritis Enrolled on 10/6/08 Attended 19 sessions 10/6/085/18/09 Height67 inc Weight270 lb272 lbs BMI4243 HTN136/83?

20. Outcomes Observed in Year 1 Recruitment - Successful (~50%) Retention - Very Successful (70-90%) Other (Spread) - Not Successful

21. Current Status Current strengths: Collaborative activities Incentive programs Interactive nature of program Retentions

22. Current Status cont … Current weaknesses: Staffing One program per five Clinics

23. Current Goals Goals and Objectives for Year 2 Spread Increase Recruitment Increase Retention

24. 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)

25. Outcomes Measurements of outcomes in Year 2 Increase BMI documentations in chart > 25% Increase referrals to = 25 / month ( original goal ) Increase recruitment to >50% of referred Increase or maintain retention at 90% Spread to at least one other clinic

26. 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

27. 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!

28. Continued Learning Goals To help with further improving our weight management program: Motivational interview Any new idea

29. Weight Management Class June 8, 2009