Introduction & Background

Aim

Methods

The purpose of this project was to implement a BMI stratification and educational

intervention to address obesity within one primary care team.

Primary Objectives:Implementation of the intervention will lead to:1. Targeted pts demonstrate greater knowledge of the risks of their BMI on their health 2. Involved staff & pts report greater satisfaction about their healthcare team3. Feedback provided feasibility of dissemination of this intervention through practice

Implementation: Pre-implementation training for MA & RN All pts scheduled for routine visits have BMI calculation of ht/wt measures, those with

BMI 30-34.9 are identified as potential participants and given 5 As by the MA as well as NIH readiness questionnaire

Pts who scored a high level of readiness (> 8 on the NIH tool) were invited to receive an RN phone call

If patient agreed to this call patient information was given to RN so f/u call could be made

PCP seeing pt reviewed information gathered by MA and addressed it in visit

Measures: BMI tracking, pre/post staff questionnaires, NIH scoring questionnaire, chart audits

The 5 As Table in BMI CounselingAnecdotally the 5 As table worked well for educating MAs about how to interact with pts about weight, and MAs often shared it with pts to talk about BMI (informally)

National data about obesity rates show an increase in frequency and a disproportionate burden on minorities (1)

In the index primary care practice BMI is calculated but not shared with the pt. Two approaches to patient counseling have been shown to be effective in evoking

weight loss - MI and the 5 As (2,3) Weight loss counseling done by support staff yields promising outcomes (1)

Implementation of an Interdisciplinary Weight Loss Counseling Intervention in Primary Care: BMI PDSAMaura Moran Brain, DNP(c), ANP Jennifer Hackel, DNP & Eileen M. Stuart-Shor, PhD, ANP

ASKASK ABOUT KNOWLEDGE OF BMI AND HEALTH?ADVISEADVISE ABOUT HEALTH RISK

ASSESSASSESS PTS READINESS AND INTEREST IN CHANGE WITH NIH READINESS TOOL

ASSISTGIVE INFO ABOUT RESOURCE OPTIONS/PRACTICE OPTIONS

ARRANGEGUIDE PTS ON NEXT STEP OF FOLLOW THROUGH ON RESOURCES (IF APPT) AND TEAM COMMUNICATION

This 6 wk QI project occurred at Healthcare Associates, a large academic primary care practice in Boston, MA

30 pts met criteria and agreed to be checked in by MAs using the algorithm

Of 30 pts 25 = female and 5 = male. Age range 24–81 yrs, mean age of 66. Average BMI = 32.5. Average weight was 188.3. Average NIH readiness score = 8.1 (range 0-10). Pts were almost exactly 50% private/50% public insurance

25 pts qualified for a (MI) RN phone call based on NIH scoring. Chart review revealed 9 pts received MI based phone call by RN. 10 pts received vm by RN (no documentation of call back). 4 pts had calls by RN where acute health concerns were addressed (MI counseling was deferred). 2 charts had no doc RN call

4 providers out of approximately 16 completed provider questionnaire. Team based care and the value of MAs in partnering with pts was universally valued in returned questionnaires

Pt questionnaires showed high rate of satisfaction with health info shared and interaction with MA

MA feedback revealed comfort with knowledge about BMI & BMI PDSA pt interactions

PDSA format was well suited for this pilot as every 2 wk reassessments allowed PI to capture data about the relationship of clinic staffing to identifying subjects for pilot (as can be seen in below annotated run chart)

Results MAs can be trained to provide well-received pt education & resources about BMI and

its connection to health RN MI phone calls were often derailed due to pt being unavailable or having a more

pressing concern to discuss Due to the short time of this QI it was hard to capture data on weight trends. As of

10/23/14 chart review revealed 8 pts had no new weights, 4 pts had no weight change, 7 pts had weight gain, 11 pts had weight loss. There was no correlation between RN calls or NIH scoring & weight loss or gained thus far in review of weights

Summary: Teaming with MAs to provide counseling to pts about BMI may be a cost effective

intervention well received by pts that could occur before a pt encounter with provider. This may help create a more informed and educated pt that, as described in the chronic care model, is more ready to engage in their healthcare

Next Steps: Assess weight changes of above participants 6 months after QI project. Explore the

feasibility of a practice-wide adoption of MA sharing a BMI chart with each pt at weigh in with a brief definition of how BMI connects to health

Conclusions

Lessons Learned Enthusiastic and invested MAs likely contributed to success of intervention RNs felt time pressures & urgent care responsibilities were a more pressing need of

their time. This likely contributed to barriers experienced connecting with pts in post visit f/u

MA staffing, late pt arrivals, and resident provider’s single room to see pt’s in were challenges that were not able to be overcome that affected the success and sustainability of this project

Limitations: Small sample of pts who were highly motivated agreed to be part of this QI project.

These pts were 5 to 1 female. Findings may not be transferrable to other types of pt populations

References:1. Dennison Himmelfarb CR. New evidence and policy support primary care-based weight loss interventions. J

Cardiovasc Nurs. 2012;27(5):379-381.2. Alexander SC, Cox ME, Boling Turer C,L., et al. Do the five A's work when physicians counsel about weight loss? Fam

Med. 2011;43(3):179-184.3. Vallis M, Piccinini-Vallis H, Sharma AM, Freedhoff Y. Clinical review: Modified 5 as: Minimal intervention for obesity

counseling in primary care. Can Fam Physician. 2013;59(1):27-31. 4. National Institute of Health. 3 Steps to initiate discussion about weight management with your patients.

http://nhibinih.gov. Accessed October 23, 2014